Provider First Line Business Practice Location Address:
149 48TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087-6428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-864-1809
Provider Business Practice Location Address Fax Number:
201-864-4077
Provider Enumeration Date:
12/26/2006