Provider First Line Business Practice Location Address:
300 GEORGE ST
Provider Second Line Business Practice Location Address:
SUITE 901, YALE UNIVERSITY DEPARTMENT OF PSYCHIARTY
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:
203-785-2117
Provider Business Practice Location Address Fax Number:
203-785-7357
Provider Enumeration Date:
05/19/2014