Provider First Line Business Practice Location Address:
1236 US HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-454-9865
Provider Business Practice Location Address Fax Number:
908-847-0248
Provider Enumeration Date:
08/20/2005