Provider First Line Business Practice Location Address:
12 HARRIS AVENUE
Provider Second Line Business Practice Location Address:
THE NEW LIFE HEALTH CENTER INC
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-524-9551
Provider Business Practice Location Address Fax Number:
617-524-0345
Provider Enumeration Date:
07/02/2008