Provider First Line Business Practice Location Address:
1750 MAIN ST
Provider Second Line Business Practice Location Address:
SAND SCHOOL DENTAL CLINIC
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06120-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-695-5056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2012