Provider First Line Business Practice Location Address:
20 WASHINGTON PL
Provider Second Line Business Practice Location Address:
3RD FLOOR VA CLINIC
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-645-3042
Provider Business Practice Location Address Fax Number:
201-781-0773
Provider Enumeration Date:
03/26/2007