Individual
SCHON C RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
HEALTH SERVICE TECH
Contact information
Practice address
15 MOHEGAN AVE, NEW LONDON, CT 06320-8100
(860) 444-8402
(860) 444-8413
Mailing address
USCG HQ, COMDT (CG-1122), 2100 2ND STREET, RM 5314, WASHINGTON, DC 20593-0001
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/23/2006
Last updated
07/08/2007
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