Provider First Line Business Practice Location Address:
1 LONG WHARF DRIVE SUITE 7
Provider Second Line Business Practice Location Address:
FORENSIC DRUG DIVERSION PROGRAM
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:
203-974-5722
Provider Business Practice Location Address Fax Number:
203-974-5705
Provider Enumeration Date:
09/29/2011