Provider First Line Business Practice Location Address:
30 CHASE AVE
Provider Second Line Business Practice Location Address:
EDMUND ERVIN PEDIATRIC CENTER
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-872-4390
Provider Business Practice Location Address Fax Number:
207-872-4294
Provider Enumeration Date:
04/26/2007