Provider First Line Business Practice Location Address:
55 FRUIT ST
Provider Second Line Business Practice Location Address:
YAW 6900 CHILD & ADOLESCENT PSYCHIATRY
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-726-4013
Provider Business Practice Location Address Fax Number:
617-726-5567
Provider Enumeration Date:
10/26/2005