Provider First Line Business Practice Location Address:
530 MAIN AVENUE
Provider Second Line Business Practice Location Address:
ST MARYS HOSPITAL SETON CENTER
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-470-3514
Provider Business Practice Location Address Fax Number:
973-470-3515
Provider Enumeration Date:
12/18/2006