Provider First Line Business Practice Location Address:
614 FRELINGHUYSEN AVE STE 44
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:
07114-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-398-2318
Provider Business Practice Location Address Fax Number:
908-304-9031
Provider Enumeration Date:
01/16/2026