Provider First Line Business Practice Location Address:
115 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-942-3635
Provider Business Practice Location Address Fax Number:
207-941-1933
Provider Enumeration Date:
01/10/2007