Provider First Line Business Practice Location Address:
9400 ATLANTIC AVENUE
Provider Second Line Business Practice Location Address:
IRVIN WIENER
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-822-8662
Provider Business Practice Location Address Fax Number:
609-822-2602
Provider Enumeration Date:
12/27/2006