Provider First Line Business Practice Location Address:
500 VINE STREET
Provider Second Line Business Practice Location Address:
CAPITOL REGION MENTAL HEALTHY CENTER
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06112-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-229-7097
Provider Business Practice Location Address Fax Number:
860-293-6338
Provider Enumeration Date:
07/25/2006