Provider First Line Business Practice Location Address:
297 SUMMER ST
Provider Second Line Business Practice Location Address:
KINGDOM RECOVERY CENTER
Provider Business Practice Location Address City Name:
ST JOHNSBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05819-2283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-748-2524
Provider Business Practice Location Address Fax Number:
802-748-2524
Provider Enumeration Date:
01/16/2007