Provider First Line Business Practice Location Address:
19 EDWARDS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-7313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-624-2146
Provider Business Practice Location Address Fax Number:
203-624-2791
Provider Enumeration Date:
01/04/2007