Provider First Line Business Practice Location Address:
601 ELMWOOD AVENUE
Provider Second Line Business Practice Location Address:
BOX 278984
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-275-8503
Provider Business Practice Location Address Fax Number:
585-276-2249
Provider Enumeration Date:
10/04/2006