Provider First Line Business Practice Location Address:
140 ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESQUE ISLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-340-8006
Provider Business Practice Location Address Fax Number:
706-625-6691
Provider Enumeration Date:
06/15/2005