Provider First Line Business Practice Location Address:
21 NO BURLINGTON RD
Provider Second Line Business Practice Location Address:
SOUTHWOOD STATE PRISON ALLCARE
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-459-7206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007