Provider First Line Business Practice Location Address:
1423 CHAPEL STREET
Provider Second Line Business Practice Location Address:
SUITE 1A
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:
203-787-4647
Provider Business Practice Location Address Fax Number:
203-785-1861
Provider Enumeration Date:
02/21/2007