Provider First Line Business Practice Location Address:
21 HIGHLAND AVE STE 2
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-463-7770
Provider Business Practice Location Address Fax Number:
978-462-0220
Provider Enumeration Date:
06/20/2005