Provider First Line Business Practice Location Address:
137 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-344-5379
Provider Business Practice Location Address Fax Number:
973-344-1988
Provider Enumeration Date:
02/09/2007