Provider First Line Business Practice Location Address:
545A CENTRE STREET
Provider Second Line Business Practice Location Address:
BETH ISRAEL DEACONESS HEALTH CARE - JP
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-522-5464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006