Provider First Line Business Practice Location Address:
BETH ISRAEL DEACONESS MED. CTR
Provider Second Line Business Practice Location Address:
330 BROOKLINE AVENUE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-667-9600
Provider Business Practice Location Address Fax Number:
617-667-9696
Provider Enumeration Date:
09/22/2006