Provider First Line Business Practice Location Address:
146 ACADEMY ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
PRESQUE ISLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04769-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-764-7900
Provider Business Practice Location Address Fax Number:
207-764-7979
Provider Enumeration Date:
06/24/2005