Provider First Line Business Practice Location Address:
1 PARK STREET
Provider Second Line Business Practice Location Address:
NEW HAVEN CHILDREN'S HOSPITAL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-4081
Provider Business Practice Location Address Fax Number:
203-737-7635
Provider Enumeration Date:
11/16/2005