Provider First Line Business Practice Location Address:
1423 CHAPEL ST
Provider Second Line Business Practice Location Address:
1 B
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-891-7134
Provider Business Practice Location Address Fax Number:
203-891-7765
Provider Enumeration Date:
01/12/2016