Provider First Line Business Practice Location Address: 
GOERGEN ATHLETIC CENTER
    Provider Second Line Business Practice Location Address: 
UNIVERSITY OF ROCHESTER
    Provider Business Practice Location Address City Name: 
ROCHESTER
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14627
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-275-4890
    Provider Business Practice Location Address Fax Number: 
585-461-5081
    Provider Enumeration Date: 
12/04/2006