Provider First Line Business Practice Location Address: 
111 FRANKLIN HEALTH CMNS
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FARMINGTON
    Provider Business Practice Location Address State Name: 
ME
    Provider Business Practice Location Address Postal Code: 
04938-6144
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
207-778-6031
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/13/2017