Provider First Line Business Practice Location Address:
THIRD AND FEDERAL STREETS
Provider Second Line Business Practice Location Address:
NEW JERSEY STATE PRISON
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08625-0861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-292-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2007