Provider First Line Business Practice Location Address:
55 LAKE AVENUE NORTH
Provider Second Line Business Practice Location Address:
UMASS MEMORIAL MEDICAL CENTER, ADULT MENTAL HEALTH UNIT
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01655-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-442-2761
Provider Business Practice Location Address Fax Number:
774-442-8357
Provider Enumeration Date:
12/01/2005