Provider First Line Business Practice Location Address:
1 S PROSPECT ST., REHAB 3
Provider Second Line Business Practice Location Address:
C/O UVM MEDICAL CENTER, PSYCHIATRY/PSYCH SVCS.
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-4696
Provider Business Practice Location Address Fax Number:
802-847-4612
Provider Enumeration Date:
12/16/2016