Provider First Line Business Practice Location Address: 
260 N HAMLIN RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HILTON
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14468-9133
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-350-6030
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/12/2009