Provider First Line Business Practice Location Address:
321 ELLIS STREET, STE 3
Provider Second Line Business Practice Location Address:
TODAY'S YOUTH, LLC
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-740-6108
Provider Business Practice Location Address Fax Number:
860-740-6510
Provider Enumeration Date:
01/15/2009