Provider First Line Business Practice Location Address:
TORONTO WESTERN HOSPITAL
Provider Second Line Business Practice Location Address:
399 BATHURST ST. ROOM MP 13-302
Provider Business Practice Location Address City Name:
TORONTO
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
M5T 2S8
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
416-603-5597
Provider Business Practice Location Address Fax Number:
416-603-5622
Provider Enumeration Date:
04/28/2008