Provider First Line Business Practice Location Address:
70 GILL AVE.
Provider Second Line Business Practice Location Address:
PAWTUCKET CENTER, GENESIS HEALTH CARE
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-722-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2012