Provider First Line Business Practice Location Address:
149 13TH ST
Provider Second Line Business Practice Location Address:
149 2301 MGH IMAGING CENTER
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-726-5122
Provider Business Practice Location Address Fax Number:
617-726-7422
Provider Enumeration Date:
02/14/2006