Provider First Line Business Practice Location Address:
199 YACHT ST
Provider Second Line Business Practice Location Address:
SERVICE COORDINATOR OFFICE
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06605-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-455-6013
Provider Business Practice Location Address Fax Number:
203-367-1935
Provider Enumeration Date:
04/30/2013