State Of Connecticut

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

Map for State Of Connecticut

Get directions of State Of Connecticut

Get directions of State Of Connecticut

If you would like to get driving directions of State Of Connecticut. Please click on the map showed above.