Organization
AMERICAN MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK KEVIN LIQUE MD (ASSOCIATE)
(617) 202-9225
Entity
Organization
Contact information
Practice address
408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
(617) 202-9225
(781) 357-1967
Mailing address
408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
(617) 202-9225
(781) 357-1967
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
498
MA
Other
Enumeration date
12/30/2011
Last updated
12/30/2011
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