Provider First Line Business Practice Location Address:
5700 W GENESEE ST
Provider Second Line Business Practice Location Address:
FAMILY CARE MEDICAL GROUP, STE. 109N
Provider Business Practice Location Address City Name:
CAMILLUS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13031-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-487-1573
Provider Business Practice Location Address Fax Number:
315-487-2418
Provider Enumeration Date:
04/20/2011