Provider First Line Business Practice Location Address:
780 SUMMER ST.
Provider Second Line Business Practice Location Address:
SOUTHWEST CT MENTAL HEALTH SYSTEM-F.S. DUBOIS CENTER
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-388-1600
Provider Business Practice Location Address Fax Number:
203-388-1684
Provider Enumeration Date:
10/18/2006