Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Nov 21, 2005
License(s)
159674 (MA), 245199 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2212 PENFIELD RD SUITE 100 | Rochester, NY 14526 | 585-598-8505 |
| MAILING | 601 ELMWOOD AVE BOX 278980 | Rochester, NY 14642-0001 |
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