Provider First Line Business Practice Location Address: 
DARTMOUTH-HITCHCOCK MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
ONE MEDICAL CENTER DRIVE
    Provider Business Practice Location Address City Name: 
LEBANON
    Provider Business Practice Location Address State Name: 
NH
    Provider Business Practice Location Address Postal Code: 
03756-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
603-650-8124
    Provider Business Practice Location Address Fax Number: 
603-650-7898
    Provider Enumeration Date: 
06/30/2006