Provider First Line Business Practice Location Address:
481-495 NORTH 13TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07107-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-481-7770
Provider Business Practice Location Address Fax Number:
201-481-7755
Provider Enumeration Date:
12/27/2010