Provider First Line Business Practice Location Address: 
QUINNIPIAC UNIVERSITY 275 MT CARMEL AVENUE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HAMDEN
    Provider Business Practice Location Address State Name: 
CT
    Provider Business Practice Location Address Postal Code: 
06511-1908
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
516-761-2034
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/24/2018