Provider First Line Business Practice Location Address:
48 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-767-5820
Provider Business Practice Location Address Fax Number:
207-799-5225
Provider Enumeration Date:
12/28/2009