Provider First Line Business Practice Location Address:
42 E. LAUREL RD, UDP AT UMDNJ-SOM
Provider Second Line Business Practice Location Address:
DEPT. OF FAMILY MEDICINE, RM 2100
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-566-6330
Provider Business Practice Location Address Fax Number:
856-566-6360
Provider Enumeration Date:
06/13/2007