Provider First Line Business Practice Location Address:
75 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
LEWISTON MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-795-4180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2010