Provider First Line Business Practice Location Address: 
601 ELMWOOD 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: 
14642-5400
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-275-4517
    Provider Business Practice Location Address Fax Number: 
585-442-9201
    Provider Enumeration Date: 
06/04/2013