Provider First Line Business Practice Location Address:
239 CRANSTON ST.
Provider Second Line Business Practice Location Address:
CENTRAL HEALTH CENTER
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02907-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-0580
Provider Business Practice Location Address Fax Number:
404-444-0428
Provider Enumeration Date:
08/30/2005