Provider First Line Business Practice Location Address:
130 CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-443-6626
Provider Business Practice Location Address Fax Number:
207-443-8142
Provider Enumeration Date:
03/19/2007