Provider First Line Business Practice Location Address: 
70 QUINCY AVE
    Provider Second Line Business Practice Location Address: 
COMMUNITY REHAB CARE
    Provider Business Practice Location Address City Name: 
QUINCY
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
02169
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
617-786-8811
    Provider Business Practice Location Address Fax Number: 
617-786-8877
    Provider Enumeration Date: 
02/12/2007