Provider First Line Business Practice Location Address: 
30 ELM AVE.
    Provider Second Line Business Practice Location Address: 
MID UPPER CAPE COMMUNITY HEALTH CENTER
    Provider Business Practice Location Address City Name: 
HYANNIS
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
02601-5547
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
508-778-5420
    Provider Business Practice Location Address Fax Number: 
508-778-8747
    Provider Enumeration Date: 
10/12/2006