Provider First Line Business Practice Location Address:
1213 CHAPEL ST
Provider Second Line Business Practice Location Address:
NEW HAVEN MEDICAL SPORTS & OCCUPATIONAL HEALTH
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:
203-776-3375
Provider Business Practice Location Address Fax Number:
203-776-3171
Provider Enumeration Date:
06/21/2006