Provider First Line Business Practice Location Address:
800 HOWARD AVE
Provider Second Line Business Practice Location Address:
YALE PHYSICIANS BLDG
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:
203-737-1204
Provider Business Practice Location Address Fax Number:
203-785-7068
Provider Enumeration Date:
11/27/2007