Provider First Line Business Practice Location Address:
589 SO FIRST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3147
Provider Business Practice Location Address Fax Number:
508-990-1465
Provider Enumeration Date:
12/30/2011