Provider First Line Business Practice Location Address:
1300 ROUTE 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-454-4047
Provider Business Practice Location Address Fax Number:
908-454-4018
Provider Enumeration Date:
10/23/2020