Provider First Line Business Practice Location Address:
20 YORK STREET CB 2041
Provider Second Line Business Practice Location Address:
NORTHEAST MEDICAL GROUP
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-688-4748
Provider Business Practice Location Address Fax Number:
203-688-4740
Provider Enumeration Date:
12/07/2010