Provider First Line Business Practice Location Address:
55 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-942-2423
Provider Business Practice Location Address Fax Number:
973-942-8674
Provider Enumeration Date:
10/16/2006