Provider First Line Business Practice Location Address: 
75 FRANICS STREET
    Provider Second Line Business Practice Location Address: 
BRIGHAM INTERNAL MEDICINE ASSOCIATES
    Provider Business Practice Location Address City Name: 
BOSTON
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
02115
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
617-732-6040
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/18/2006