Provider First Line Business Practice Location Address:
635 FERGUSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-319-5971
Provider Business Practice Location Address Fax Number:
908-408-4150
Provider Enumeration Date:
02/03/2026