Provider First Line Business Practice Location Address:
151 KNOLLCROFT RD (561/11E)
Provider Second Line Business Practice Location Address:
EXTENDED CARE OFFICE, LYONS VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-647-0180
Provider Business Practice Location Address Fax Number:
908-604-5226
Provider Enumeration Date:
07/24/2006