Provider First Line Business Practice Location Address: 
231 EAST SPRUCE STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
EAST ROCHESTER
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14445
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
716-378-4280
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/18/2012