Provider First Line Business Practice Location Address:
419 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-849-8783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2009