Provider First Line Business Practice Location Address:
209 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
BASEMENT INSIDE BACK BAY CROSSFITS
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02116-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-429-3577
Provider Business Practice Location Address Fax Number:
617-375-8581
Provider Enumeration Date:
11/10/2006