Provider First Line Business Practice Location Address:
905 PLYMOUTH AVE S
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:
14608-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-661-1445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2025