Provider First Line Business Practice Location Address:
111 BREWSTER ST
Provider Second Line Business Practice Location Address:
MEMORIAL HOSPITAL OF RI /DEPT OF SURGERY
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-729-2241
Provider Business Practice Location Address Fax Number:
401-729-2286
Provider Enumeration Date:
06/15/2006