Provider First Line Business Practice Location Address:
150 OCEAN AVE
Provider Second Line Business Practice Location Address:
OCEAN AVE. ELEM OCEAN AVENUE ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-874-8180
Provider Business Practice Location Address Fax Number:
207-874-1021
Provider Enumeration Date:
04/12/2011