Provider First Line Business Practice Location Address:
226 DIXWELL AVE
Provider Second Line Business Practice Location Address:
NORTHSIDE COMMUNITY OUTPATIENT SERVICES
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-503-3470
Provider Business Practice Location Address Fax Number:
203-503-3478
Provider Enumeration Date:
04/07/2017