Provider First Line Business Practice Location Address:
187 LEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08070-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-430-3697
Provider Business Practice Location Address Fax Number:
856-494-1960
Provider Enumeration Date:
10/28/2026