Provider First Line Business Practice Location Address:
392 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06604-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-576-9041
Provider Business Practice Location Address Fax Number:
203-334-7798
Provider Enumeration Date:
01/24/2008