Provider First Line Business Practice Location Address:
55 FRUIT ST
Provider Second Line Business Practice Location Address:
PEDIATRIC CRITICAL CARE UNIT ELL 317
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-724-4381
Provider Business Practice Location Address Fax Number:
617-724-4391
Provider Enumeration Date:
12/01/2005