Provider First Line Business Practice Location Address:
800 HOWARD AVE
Provider Second Line Business Practice Location Address:
YALE PHYSICIANS BUILDING
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-2140
Provider Business Practice Location Address Fax Number:
203-785-6414
Provider Enumeration Date:
11/29/2005