Provider First Line Business Practice Location Address:
UPHAM'S CORNER HEALTH CENTER, 500 COLUMBIA ROAD
Provider Second Line Business Practice Location Address:
MAIL STOP 415-01
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-287-8000
Provider Business Practice Location Address Fax Number:
617-740-8070
Provider Enumeration Date:
09/05/2006