Provider First Line Business Practice Location Address:
6 SCHOOL ST
Provider Second Line Business Practice Location Address:
NOAH WALLACE SCHOOL
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-677-1791
Provider Business Practice Location Address Fax Number:
860-676-9336
Provider Enumeration Date:
02/20/2007