Provider First Line Business Practice Location Address:
119-137 CLIFFORD STREET
Provider Second Line Business Practice Location Address:
L-3A
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-648-6808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006