Provider First Line Business Practice Location Address: 
1044 BELMONT AVENUE
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF MEDICAL EDUCATION
    Provider Business Practice Location Address City Name: 
YOUNGSTOWN
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44501-1006
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
617-223-7806
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/13/2010