Provider First Line Business Practice Location Address:
141 E MAIN ST
Provider Second Line Business Practice Location Address:
HOME BASED SERVICES-3RD FLOOR
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-575-0486
Provider Business Practice Location Address Fax Number:
203-575-1817
Provider Enumeration Date:
07/28/2015