Provider First Line Business Practice Location Address:
144 THADEUS ST.
Provider Second Line Business Practice Location Address:
SUITE 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-544-9800
Provider Business Practice Location Address Fax Number:
207-544-9900
Provider Enumeration Date:
06/17/2011