Provider First Line Business Practice Location Address:
89 SPARTA AVE
Provider Second Line Business Practice Location Address:
270
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-409-0113
Provider Business Practice Location Address Fax Number:
570-296-8110
Provider Enumeration Date:
12/18/2006