Provider First Line Business Practice Location Address:
149 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07201-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-352-4314
Provider Business Practice Location Address Fax Number:
908-352-3530
Provider Enumeration Date:
05/01/2007