Provider First Line Business Practice Location Address:
HEALTH SCIENCES CENTER
Provider Second Line Business Practice Location Address:
300 PRINCE PHILIPS DRIVE
Provider Business Practice Location Address City Name:
ST. JOHN'S
Provider Business Practice Location Address State Name:
NEWFOUNDLAND
Provider Business Practice Location Address Postal Code:
A1B 3V6
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
709-777-8512
Provider Business Practice Location Address Fax Number:
709-777-6656
Provider Enumeration Date:
11/20/2009