Provider First Line Business Practice Location Address:
656 STATE ST
Provider Second Line Business Practice Location Address:
DOROTHEA DIX PSYCHIATRIC CENTER
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-5609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-941-4263
Provider Business Practice Location Address Fax Number:
207-941-4151
Provider Enumeration Date:
10/12/2006