Provider First Line Business Practice Location Address:
1153 CENTRE ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-983-7922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006