Provider First Line Business Practice Location Address:
198 NEW YORK AVE
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07307-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-360-3006
Provider Business Practice Location Address Fax Number:
201-360-3006
Provider Enumeration Date:
07/08/2009