Provider First Line Business Practice Location Address:
70 KENYON AVE
Provider Second Line Business Practice Location Address:
SOUTH COUNTY MEDICAL OFFICE BUILDING SUITE #212
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-789-8912
Provider Business Practice Location Address Fax Number:
401-782-8702
Provider Enumeration Date:
04/28/2006