Provider First Line Business Practice Location Address:
7 COURT ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF HEALTH, ROOM 30
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14813-1076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-268-9250
Provider Business Practice Location Address Fax Number:
585-268-9264
Provider Enumeration Date:
09/14/2010