NPI Provider: 1720083769
Contact Name: Atkins Ellie
Position: Provider Enrollment Coordinator
Phone: (860) 523-6421
State Of Connecticut Information:
State Of Connecticut organization have npi 1720083769, taxonomy code is 208D00000X with license number is 637070 in . This Business address located in 65 Kane St, West Hartford, CT 61192 Connecticut.
Practice Location
Address: 263 Farmington Ave, Farmington, CT 60300
Phone: (860) 523-6421
Business Location
Address: 65 Kane St, West Hartford, CT 61192
Phone: (860) 523-6421
Fax: (860) 523-3701
Taxonomy
Taxonomy Code: 208D00000X
License Number: 637070
License Number of State: CT
Primary Taxonomy Switch: Y
Enumeration Date: 6/16/2005
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