Provider First Line Business Practice Location Address:
125 WINTERGREEN AVE
Provider Second Line Business Practice Location Address:
SOUTHERN CONNECTICUT STATE UNIVERSITY - MFH
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06515-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-392-6007
Provider Business Practice Location Address Fax Number:
203-392-6200
Provider Enumeration Date:
06/21/2006