Provider First Line Business Practice Location Address:
610 WATERMAN AVE
Provider Second Line Business Practice Location Address:
EAST PROVIDENCE SENIOR CENTER
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-435-2106
Provider Business Practice Location Address Fax Number:
401-435-2133
Provider Enumeration Date:
08/10/2006