Provider First Line Business Practice Location Address: 
550 DOUGLAS PIKE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SMITHFIELD
    Provider Business Practice Location Address State Name: 
RI
    Provider Business Practice Location Address Postal Code: 
02917-2347
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
401-233-3350
    Provider Business Practice Location Address Fax Number: 
401-233-2251
    Provider Enumeration Date: 
11/10/2011