Provider First Line Business Practice Location Address:
550 LATONA RD
Provider Second Line Business Practice Location Address:
WATONA OFFICE CAMPUS BLDG B DAVD HICKSON LCSWR
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-234-0018
Provider Business Practice Location Address Fax Number:
585-697-2078
Provider Enumeration Date:
03/01/2007