Provider First Line Business Practice Location Address:
789 HOWARD AVENUE, FMP 315A
Provider Second Line Business Practice Location Address:
YALE UNIVERSITY, DEPT OF UROLOGY
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:
203-785-2815
Provider Business Practice Location Address Fax Number:
203-785-4043
Provider Enumeration Date:
07/25/2007