Provider First Line Business Practice Location Address:
991 MAIN ST
Provider Second Line Business Practice Location Address:
UNIT 1B
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-1000
Provider Business Practice Location Address Fax Number:
973-754-1010
Provider Enumeration Date:
03/29/2018