Provider First Line Business Practice Location Address:
88 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
ADULT BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-573-7265
Provider Business Practice Location Address Fax Number:
203-573-7578
Provider Enumeration Date:
11/22/2005