Provider First Line Business Practice Location Address:
26 NORTH ELM ST.
Provider Second Line Business Practice Location Address:
MORRIS RECOVERY HOUSE
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-574-3986
Provider Business Practice Location Address Fax Number:
203-597-5459
Provider Enumeration Date:
04/18/2014