Provider First Line Business Practice Location Address:
300 CENTRAL AVE
Provider Second Line Business Practice Location Address:
AT EAST ORANGE GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07018-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-364-4674
Provider Business Practice Location Address Fax Number:
973-673-3160
Provider Enumeration Date:
03/26/2007