Provider First Line Business Practice Location Address:
200 HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
APT 301
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-3072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-833-8745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2012