Provider First Line Business Practice Location Address:
540 E 23RD ST APT 8
Provider Second Line Business Practice Location Address:
APT 8
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07514-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-456-8874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2025