Provider First Line Business Practice Location Address: 
138 WEBSTER STREET
    Provider Second Line Business Practice Location Address: 
ELLIOT SENIOR HEALTH CENTER
    Provider Business Practice Location Address City Name: 
MANCHESTER
    Provider Business Practice Location Address State Name: 
NH
    Provider Business Practice Location Address Postal Code: 
03104
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
603-663-7030
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/25/2006