Provider First Line Business Practice Location Address:
191 GRANITE ST
Provider Second Line Business Practice Location Address:
OFFICE OF SPECIAL SERVICES
Provider Business Practice Location Address City Name:
MILLINOCKET
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04462-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-723-6404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010