Provider First Line Business Practice Location Address:
1139 EAST JERSEY ST
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-393-4949
Provider Business Practice Location Address Fax Number:
609-393-0064
Provider Enumeration Date:
08/04/2023