Provider First Line Business Practice Location Address:
7076 STATE ROUTE 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-721-5077
Provider Business Practice Location Address Fax Number:
732-721-8049
Provider Enumeration Date:
02/21/2007