Individual
TAVARES CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
89 ROCHELA DR, SOUTHINGTON, CT 06489-4670
(860) 781-1973
Mailing address
89 ROCHELA DR, SOUTHINGTON, CT 06489-4670
(860) 781-1973
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
0002272
CT
Other
Enumeration date
09/07/2023
Last updated
09/07/2023
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