Provider First Line Business Mailing Address: 
20 YORK STREET
    Provider Second Line Business Mailing Address: 
YALE-NEW HAVEN HOSPITAL, SW DEPT
    Provider Business Mailing Address City Name: 
NEW HAVEN
    Provider Business Mailing Address State Name: 
CT
    Provider Business Mailing Address Postal Code: 
06510
    Provider Business Mailing Address Country Code: 
US
    Provider Business Mailing Address Telephone Number: 
203-688-2195
    Provider Business Mailing Address Fax Number: 
203-453-7169