Provider First Line Business Practice Location Address:
915 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PHYSICAL EDUCATION RECREATION AND DANCE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-358-1890
Provider Business Practice Location Address Fax Number:
617-358-3747
Provider Enumeration Date:
07/24/2007