Provider First Line Business Practice Location Address:
C/O NORTHEAST MEDICAL GROUP, INC.
Provider Second Line Business Practice Location Address:
226 MILL HILL AVE., 3RD FLOOR
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
475-319-6035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2006