Provider First Line Business Practice Location Address:
217 OLD HOOK RD
Provider Second Line Business Practice Location Address:
SUITE 3C GARDEN STATE PEDIATRICS LLC
Provider Business Practice Location Address City Name:
WESTWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-263-1477
Provider Business Practice Location Address Fax Number:
201-263-0048
Provider Enumeration Date:
09/06/2006