Provider First Line Business Practice Location Address:
216 19TH ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-436-4704
Provider Business Practice Location Address Fax Number:
973-436-4714
Provider Enumeration Date:
11/15/2025