Provider First Line Business Practice Location Address:
144 STATE ST
Provider Second Line Business Practice Location Address:
DEPT OF CLINICAL NUTRITION
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-3776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-879-3597
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2014