Provider First Line Business Practice Location Address: 
WOODBRIDGE DEVELOPMENTAL CENTER
    Provider Second Line Business Practice Location Address: 
RAHWAY AVENUE
    Provider Business Practice Location Address City Name: 
WOODBRIDGE
    Provider Business Practice Location Address State Name: 
NJ
    Provider Business Practice Location Address Postal Code: 
07095-0189
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
732-499-5951
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/26/2006