Provider First Line Business Practice Location Address:
1 VA CTR
Provider Second Line Business Practice Location Address:
PROSTHETIC SERVICE (126P)
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-623-5769
Provider Business Practice Location Address Fax Number:
207-623-5779
Provider Enumeration Date:
08/21/2006