Provider First Line Business Practice Location Address:
360 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
SCHOOL BASE CLINIC
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
475-220-7619
Provider Business Practice Location Address Fax Number:
475-220-7618
Provider Enumeration Date:
09/16/2009