Provider First Line Business Practice Location Address:
55 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 410 WESTERN CONNECTICUT MENTAL HEALTH NETWORK
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-805-6408
Provider Business Practice Location Address Fax Number:
203-805-6432
Provider Enumeration Date:
11/14/2006