Provider First Line Business Practice Location Address:
111 CENTRAL AVE
Provider Second Line Business Practice Location Address:
ST. MICHAEL'S MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-877-5413
Provider Business Practice Location Address Fax Number:
973-877-2712
Provider Enumeration Date:
04/13/2007