Provider First Line Business Practice Location Address:
545 A CENTRE ST
Provider Second Line Business Practice Location Address:
BETH ISRAEL DEACONESS HEALTH CARE - JAMAICA PLAIN
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-522-5464
Provider Business Practice Location Address Fax Number:
617-524-2966
Provider Enumeration Date:
08/10/2005