Provider First Line Business Practice Location Address:
150 GRIFFIN RD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-427-5122
Provider Business Practice Location Address Fax Number:
603-427-5124
Provider Enumeration Date:
08/31/2006