Provider First Line Business Practice Location Address:
990 SOUTH AVENUE
Provider Second Line Business Practice Location Address:
PROFESSIONAL OFFICE BUILDING, SUITE 020
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-341-8017
Provider Business Practice Location Address Fax Number:
585-341-8308
Provider Enumeration Date:
10/02/2012