Provider First Line Business Practice Location Address:
480 HAWTHORN STREET
Provider Second Line Business Practice Location Address:
SOUTHCOAST PHYSICIAN SERVICES, INC.
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-993-3555
Provider Business Practice Location Address Fax Number:
508-990-1176
Provider Enumeration Date:
11/15/2010