Provider First Line Business Practice Location Address:
12 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-351-3530
Provider Business Practice Location Address Fax Number:
207-351-3574
Provider Enumeration Date:
01/16/2008