Provider First Line Business Practice Location Address: 
18 OLD ETNA RD
    Provider Second Line Business Practice Location Address: 
DHMC - INTERNAL MEDICINE
    Provider Business Practice Location Address City Name: 
LEBANON
    Provider Business Practice Location Address State Name: 
NH
    Provider Business Practice Location Address Postal Code: 
03766
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
603-650-4000
    Provider Business Practice Location Address Fax Number: 
603-650-4190
    Provider Enumeration Date: 
08/22/2006