Provider First Line Business Practice Location Address:
110 BERGEN STREET
Provider Second Line Business Practice Location Address:
NEW JERSEY DENTAL SCHOOL
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:
973-972-4634
Provider Business Practice Location Address Fax Number:
973-972-3689
Provider Enumeration Date:
03/02/2007