Provider First Line Business Practice Location Address:
200 HIGH SERVICE AVENUE
Provider Second Line Business Practice Location Address:
OUR LADY OF FATIMA HOSPITAL
Provider Business Practice Location Address City Name:
NORTH PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-401-2386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2012