Provider First Line Business Practice Location Address:
152 WEST ST
Provider Second Line Business Practice Location Address:
WESTERN CT MEDICAL ST (UPPER LEVEL)
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-6361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-791-5140
Provider Business Practice Location Address Fax Number:
203-739-8959
Provider Enumeration Date:
08/24/2007