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Individual

MS. CARLY MAXIMA FAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
780 AMERICAN LEGION HWY, ROSLINDALE, MA 02131-3908
(617) 469-8557
Mailing address
33 WINTER ST, ARLINGTON, MA 02474-6919
(215) 313-5377

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
05/25/2010
Last updated
05/25/2010
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