Provider First Line Business Practice Location Address:
195 1/2 NEWARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-432-6750
Provider Business Practice Location Address Fax Number:
201-432-2931
Provider Enumeration Date:
10/08/2015