Provider First Line Business Practice Location Address:
305 SOUTH STREET
Provider Second Line Business Practice Location Address:
MASS. BIOLOGIC LABORATORIES
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-983-6419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2006