Provider First Line Business Practice Location Address:
188 PROVIDENCE STREET
Provider Second Line Business Practice Location Address:
BOSTON PAIN CLINIC
Provider Business Practice Location Address City Name:
HYDE PARK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-361-2166
Provider Business Practice Location Address Fax Number:
617-364-3871
Provider Enumeration Date:
10/22/2010