Provider First Line Business Practice Location Address:
593 EDDY STREET, APC-6
Provider Second Line Business Practice Location Address:
LIFESPAN PHYSICIAN'S GROUP, DEPT OF NEUROSURGERY
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-793-9138
Provider Business Practice Location Address Fax Number:
401-444-2781
Provider Enumeration Date:
02/27/2006