Provider First Line Business Practice Location Address:
1115 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
SOUTH BAY MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
150-855-9047
Provider Business Practice Location Address Fax Number:
150-842-7536
Provider Enumeration Date:
01/10/2011