Provider First Line Business Practice Location Address: 
2425 CLOVER ST
    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: 
14618-4517
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-271-3323
    Provider Business Practice Location Address Fax Number: 
585-271-3324
    Provider Enumeration Date: 
01/09/2021