| River Of Life Medical, Llc | |
|
1370 Dorchester Ave Ste 21 Dorchester MA 02122-2921 | |
| (617) 596-1092 | |
| Not Available |
| Full Name | River Of Life Medical, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1370 Dorchester Ave Ste 21, Dorchester, Massachusetts |
| Authorized Official Name and Position | Daniel Sanghyun Cagua-koo (OWNER) |
| Authorized Official Contact | 6175961092 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| River Of Life Medical, Llc 1370 Dorchester Ave Ste 21 Dorchester MA 02122-2921 Ph: () - | River Of Life Medical, Llc 1370 Dorchester Ave Ste 21 Dorchester MA 02122-2921 Ph: (617) 596-1092 |
| NPI Number | 1710241245 |
|---|---|
| Provider Enumeration Date | 06/29/2012 |
| Last Update Date | 06/29/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710241245 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 247965 (Massachusetts) | Primary |
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