Provider First Line Business Practice Location Address:
MAPLE RIDGE CLINICAL SERVICES, 1066 STORRS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORRS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-477-1515
Provider Business Practice Location Address Fax Number:
860-429-2949
Provider Enumeration Date:
01/12/2006