Provider First Line Business Practice Location Address:
850 WATERMAN AVE
Provider Second Line Business Practice Location Address:
CODAC EAST BAY
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-434-4999
Provider Business Practice Location Address Fax Number:
401-434-6116
Provider Enumeration Date:
04/18/2007