Provider First Line Business Practice Location Address:
UPA
Provider Second Line Business Practice Location Address:
183 SOUTH ORANGE AVE
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-2977
Provider Business Practice Location Address Fax Number:
973-973-2979
Provider Enumeration Date:
01/29/2007