Individual
BALY JUAN SEO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(679) 860-2000
Mailing address
10 TALCOTT RIDGE RD UNIT G, FARMINGTON, CT 06032-3513
(959) 225-0288
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
13568
CT
Other
Enumeration date
08/22/2022
Last updated
09/06/2022
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