Individual
MRS. MOIRA ETHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-9247
Mailing address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-9247
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000963
CT
Other
Enumeration date
05/06/2015
Last updated
05/06/2015
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