Provider First Line Business Practice Location Address:
1 WEST BROADWAY
Provider Second Line Business Practice Location Address:
WEST BROADWAY DENTAL
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-684-3803
Provider Business Practice Location Address Fax Number:
973-742-8223
Provider Enumeration Date:
02/21/2007