Provider First Line Business Practice Location Address:
120-152 48TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-330-1606
Provider Business Practice Location Address Fax Number:
201-330-7622
Provider Enumeration Date:
07/06/2006