Provider First Line Business Practice Location Address:
201 HUMBOLDT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-427-2222
Provider Business Practice Location Address Fax Number:
617-427-2205
Provider Enumeration Date:
10/17/2011