Provider First Line Business Practice Location Address:
55 LAKE AVENUE NORTH
Provider Second Line Business Practice Location Address:
DEPARTMENT OF UROLOGY
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01655-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-334-8765
Provider Business Practice Location Address Fax Number:
774-443-7360
Provider Enumeration Date:
06/15/2007