Provider First Line Business Practice Location Address:
14 SHIRLEY ST
Provider Second Line Business Practice Location Address:
UNIT C-1
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02746-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-993-5113
Provider Business Practice Location Address Fax Number:
508-984-3389
Provider Enumeration Date:
09/15/2007