Provider First Line Business Practice Location Address:
1 COLLEGE CIR
Provider Second Line Business Practice Location Address:
SUNY GENESEO-HOLCOMB BUILDING
Provider Business Practice Location Address City Name:
GENESEO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14454-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-245-5688
Provider Business Practice Location Address Fax Number:
585-245-5685
Provider Enumeration Date:
12/17/2008