Provider First Line Business Practice Location Address: 
LAHEY MEDICAL CENTER, PEABODY
    Provider Second Line Business Practice Location Address: 
1 ESSEX CENTER DRIVE
    Provider Business Practice Location Address City Name: 
PEABODY
    Provider Business Practice Location Address State Name: 
MA
    Provider Business Practice Location Address Postal Code: 
01960-2901
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
781-744-7000
    Provider Business Practice Location Address Fax Number: 
978-538-4711
    Provider Enumeration Date: 
04/16/2015