Provider First Line Business Practice Location Address:
1071 KEMPTON 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:
02740-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-984-0050
Provider Business Practice Location Address Fax Number:
508-984-0049
Provider Enumeration Date:
08/17/2006