Provider First Line Business Practice Location Address:
263 FARMINGTON AVE # MC-3905
Provider Second Line Business Practice Location Address:
UCONN SCHOOL OF DENTAL MEDICINE
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06030-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-679-2364
Provider Business Practice Location Address Fax Number:
860-679-7507
Provider Enumeration Date:
12/26/2006