Provider First Line Business Practice Location Address:
218 AUTUMN ST.
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-815-0053
Provider Business Practice Location Address Fax Number:
973-815-0024
Provider Enumeration Date:
06/27/2007