Provider First Line Business Practice Location Address:
151 KNOLLCROFT RD
Provider Second Line Business Practice Location Address:
EXTENDED CARE LINE
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-766-3990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006