Provider First Line Business Practice Location Address: 
85 E NEWTON STREET
    Provider Second Line Business Practice Location Address: 
DR. SOLOMON CARTER FULLER MENTAL HEALTH CENTER
    Provider Business Practice Location Address City Name: 
BOSTON
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
02118
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
617-626-9200
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/22/2014