Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2012-12-28
- Last updated
- 2012-12-28
Specialties
Licenses
- License CT
- 002122
Location
- Practice location
- 48 SOUTH RD # 8
- City
- SOMERS CT
- Postal code
- 060712160
- Phone
- 860-763-4733
Organization contact
- Name
- STEVEN SQUILLACE
- Title
- member
- Phone
- 8607634733
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
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