Provider First Line Business Practice Location Address:
FREEMAN ATHLETIC CENTER
Provider Second Line Business Practice Location Address:
WESLEYAN UNIVERSITY
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06459-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-685-3068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2005