Provider First Line Business Practice Location Address:
500 VINE STREET
Provider Second Line Business Practice Location Address:
CAPITOL REGION MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-297-0905
Provider Business Practice Location Address Fax Number:
860-297-0914
Provider Enumeration Date:
11/28/2006