Provider First Line Business Practice Location Address:
THREE KEANEY ROAD
Provider Second Line Business Practice Location Address:
URI SPORTS MEDICINE SUITE ONE
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02881-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-874-2051
Provider Business Practice Location Address Fax Number:
401-874-4804
Provider Enumeration Date:
08/31/2016