Provider First Line Business Practice Location Address:
95 MERRITT BLVD
Provider Second Line Business Practice Location Address:
ST. VINCENT'S SPECIAL NEEDS SERVICES
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-386-2744
Provider Business Practice Location Address Fax Number:
203-386-2738
Provider Enumeration Date:
06/27/2007