Provider First Line Business Practice Location Address:
92 GRAPE ST
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:
02740-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-991-4100
Provider Business Practice Location Address Fax Number:
508-994-2103
Provider Enumeration Date:
09/17/2006