Provider First Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY, QUEEN'S UNIVERSITY
Provider Second Line Business Practice Location Address:
C/O PROVIDENCE CARE, ROOM 1076, 752 KING STREET WEST
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
K7L 4X3
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
613-548-5567
Provider Business Practice Location Address Fax Number:
613-548-5580
Provider Enumeration Date:
05/01/2007