Provider First Line Business Practice Location Address:
548 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879-1262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-316-2391
Provider Business Practice Location Address Fax Number:
732-316-2348
Provider Enumeration Date:
04/17/2007