Provider First Line Business Practice Location Address: 
155 CENTER ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AUBURN
    Provider Business Practice Location Address State Name: 
ME
    Provider Business Practice Location Address Postal Code: 
04210-5229
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
207-784-5120
    Provider Business Practice Location Address Fax Number: 
207-786-8150
    Provider Enumeration Date: 
02/20/2008