Provider First Line Business Practice Location Address:
319 W JERSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07202-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-355-5454
Provider Business Practice Location Address Fax Number:
908-355-5483
Provider Enumeration Date:
10/28/2006