Provider First Line Business Practice Location Address:
192 S MAIN ST
Provider Second Line Business Practice Location Address:
REAR ENTRANCE
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-379-6403
Provider Business Practice Location Address Fax Number:
860-788-6777
Provider Enumeration Date:
12/10/2010