Provider First Line Business Practice Location Address:
38 CRAFTS ST
Provider Second Line Business Practice Location Address:
SQUARE PSYCHIATRY, FIRST FLOOR
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02458-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-916-5069
Provider Business Practice Location Address Fax Number:
617-467-4073
Provider Enumeration Date:
12/18/2006