Provider First Line Business Practice Location Address:
915 UNION ST
Provider Second Line Business Practice Location Address:
SUITE 4, EASTERN MAINE HEALTHCARE MALL
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-8030
Provider Business Practice Location Address Fax Number:
207-973-6005
Provider Enumeration Date:
08/01/2006