Provider First Line Business Practice Location Address:
156 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-324-5480
Provider Business Practice Location Address Fax Number:
201-490-7513
Provider Enumeration Date:
01/16/2026