Provider First Line Business Practice Location Address: 
1415 MONROE 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: 
14618-1007
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
585-760-4981
    Provider Business Practice Location Address Fax Number: 
585-262-3325
    Provider Enumeration Date: 
07/14/2014