Provider First Line Business Practice Location Address:
73 FERRY ST
Provider Second Line Business Practice Location Address:
745 BERGEN AVE
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-681-5054
Provider Business Practice Location Address Fax Number:
347-681-5853
Provider Enumeration Date:
03/20/2013