Provider First Line Business Practice Location Address:
2279 MOUNT VERNON RD
Provider Second Line Business Practice Location Address:
LINCOLN COLLEGE OF NEW ENGLAND DENTAL DEPT ATTN R RYAN
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-426-0467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2005