Provider First Line Business Practice Location Address: 
207 STRYKERS RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PHILLIPSBURG
    Provider Business Practice Location Address State Name: 
NJ
    Provider Business Practice Location Address Postal Code: 
08865-5401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
908-859-6568
    Provider Business Practice Location Address Fax Number: 
908-859-6697
    Provider Enumeration Date: 
03/24/2006