Provider First Line Business Practice Location Address:
INTERMED ON SITE AT LLBEAN OFC SOUTHEND
Provider Second Line Business Practice Location Address:
7 CAMPUS DRIVE
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04033-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-552-7452
Provider Business Practice Location Address Fax Number:
207-552-7129
Provider Enumeration Date:
06/29/2015