Provider First Line Business Practice Location Address:
603 SALEM STREET SUITE 3
Provider Second Line Business Practice Location Address:
KJC MEDI WEIGHTLOSS, LLC
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-245-6334
Provider Business Practice Location Address Fax Number:
781-245-6332
Provider Enumeration Date:
05/25/2006