Provider First Line Business Practice Location Address:
189 PROUTY DR
Provider Second Line Business Practice Location Address:
NORTH COUNTRY GENERAL HOSPITAL - SUITE 504
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855-9326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-334-4104
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006