Provider First Line Business Practice Location Address:
84 PLEASANT STREET
Provider Second Line Business Practice Location Address:
SUITE 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-834-3189
Provider Business Practice Location Address Fax Number:
207-834-3395
Provider Enumeration Date:
05/08/2007