Provider First Line Business Practice Location Address:
150 BERGEN ST
Provider Second Line Business Practice Location Address:
UH C318 UMDNJ NEW JERSEY MEDICAL SCHOOL
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-5601
Provider Business Practice Location Address Fax Number:
973-972-7429
Provider Enumeration Date:
10/02/2006