Provider First Line Business Practice Location Address:
225 HIGH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04605-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-667-3732
Provider Business Practice Location Address Fax Number:
207-667-2852
Provider Enumeration Date:
08/27/2006