Provider First Line Business Practice Location Address:
14 N MAIN ST STE 4002
Provider Second Line Business Practice Location Address:
GRANITE CITY PRIMARY CARE
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05641-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-479-2546
Provider Business Practice Location Address Fax Number:
802-479-1346
Provider Enumeration Date:
05/19/2006