Provider First Line Business Practice Location Address: 
288 BEDFORD STREET
    Provider Second Line Business Practice Location Address: 
BASMI WHITMAN COUNSELING CENTER
    Provider Business Practice Location Address City Name: 
WHITMAN
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
02382
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
781-447-6425
    Provider Business Practice Location Address Fax Number: 
781-447-1786
    Provider Enumeration Date: 
11/20/2006