Provider First Line Business Practice Location Address:
601 ELMWOOD AVE BOX 638
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14642-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-276-3417
Provider Business Practice Location Address Fax Number:
585-756-5582
Provider Enumeration Date:
09/28/2011