Provider First Line Business Practice Location Address:
1423 CHAPEL STREET
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-865-3852
Provider Business Practice Location Address Fax Number:
203-865-2983
Provider Enumeration Date:
07/26/2006