Provider First Line Business Practice Location Address:
ROUTE 12 BLDG 449
Provider Second Line Business Practice Location Address:
ATTN PROFESSIONAL AFFAIRS NAVAL AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-694-2377
Provider Business Practice Location Address Fax Number:
860-694-2590
Provider Enumeration Date:
11/17/2005