Provider First Line Business Practice Location Address:
500 KINGS HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-995-9493
Provider Business Practice Location Address Fax Number:
508-995-9932
Provider Enumeration Date:
11/24/2006