Provider First Line Business Practice Location Address:
150 BERGEN STREET
Provider Second Line Business Practice Location Address:
DEPTPARTMENT OF EMERGENCY ROOM M-219
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07101-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-1193
Provider Business Practice Location Address Fax Number:
973-972-6646
Provider Enumeration Date:
09/04/2008