Provider First Line Business Practice Location Address:
LEMUEL SHATTUCK HOSPITAL
Provider Second Line Business Practice Location Address:
170 MORTON STREET
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-971-3337
Provider Business Practice Location Address Fax Number:
617-971-3852
Provider Enumeration Date:
04/12/2018