Provider First Line Business Practice Location Address:
232 MOUNT VERNON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-461-9008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2012