Provider First Line Business Practice Location Address: 
1160 CHILI AVE STE 200
    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: 
14624-3035
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-500-4814
    Provider Business Practice Location Address Fax Number: 
585-697-0221
    Provider Enumeration Date: 
03/25/2008