Provider First Line Business Practice Location Address:
885 BROADWAY
Provider Second Line Business Practice Location Address:
BANGOR HIGH SCHOOL
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-992-5574
Provider Business Practice Location Address Fax Number:
207-941-6212
Provider Enumeration Date:
02/27/2007