Provider First Line Business Practice Location Address:
11 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 102 OLDE FIREHALL SQUARE
Provider Business Practice Location Address City Name:
FORT KENT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04743-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-834-3011
Provider Business Practice Location Address Fax Number:
207-834-3011
Provider Enumeration Date:
12/19/2005