Provider First Line Business Practice Location Address:
950 CAMPBELL AVE
Provider Second Line Business Practice Location Address:
11ACSL, PRIMARY CARE FIRM B
Provider Business Practice Location Address City Name:
WEST HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-937-4918
Provider Business Practice Location Address Fax Number:
203-937-3403
Provider Enumeration Date:
09/21/2006