Provider First Line Business Practice Location Address:
180 RIDGEWAY AVE
Provider Second Line Business Practice Location Address:
JOHN MARSHALL HIGH SCHOOL
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14615-3636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-458-2110
Provider Business Practice Location Address Fax Number:
585-458-8092
Provider Enumeration Date:
12/09/2009