Provider First Line Business Practice Location Address:
ROUTE 12 BLDG 449 PROFESSIONAL AFFAIRS
Provider Second Line Business Practice Location Address:
NAVAL AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-694-2377
Provider Business Practice Location Address Fax Number:
860-694-2590
Provider Enumeration Date:
11/02/2005