Provider First Line Business Practice Location Address:
248 SOUTH SUMMIT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-342-0770
Provider Business Practice Location Address Fax Number:
201-342-7529
Provider Enumeration Date:
10/31/2006