Provider First Line Business Practice Location Address:
BETH ISRAEL DEACONESS MEDICAL CENTER
Provider Second Line Business Practice Location Address:
330 BROOKLINE AVENUE W/SPAN-2
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-0346
Provider Business Practice Location Address Fax Number:
617-754-8653
Provider Enumeration Date:
07/07/2009