Provider First Line Business Practice Location Address:
402 E MAIN ST
Provider Second Line Business Practice Location Address:
WATERBURY OP ADULT SERVICES
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:
203-755-1143
Provider Business Practice Location Address Fax Number:
203-753-3274
Provider Enumeration Date:
07/28/2015