Provider First Line Business Practice Location Address:
401 WEST THAMES STREET
Provider Second Line Business Practice Location Address:
SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-859-4760
Provider Business Practice Location Address Fax Number:
860-859-4672
Provider Enumeration Date:
12/20/2006