Provider First Line Business Practice Location Address:
675 MAIN ST
Provider Second Line Business Practice Location Address:
MARKETPLACE MALL THE COMMONS
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-786-6989
Provider Business Practice Location Address Fax Number:
207-786-6990
Provider Enumeration Date:
03/15/2007