Provider First Line Business Practice Location Address:
20 WASHINGTON PLACE
Provider Second Line Business Practice Location Address:
ROOM 329
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-3174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-645-3042
Provider Business Practice Location Address Fax Number:
973-622-4813
Provider Enumeration Date:
09/12/2006