Provider First Line Business Practice Location Address:
1 SOUTH PROSPECT STREET
Provider Second Line Business Practice Location Address:
UHC ST JOSEPHS WING 3RD FLOOR
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-656-2796
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2008