Provider First Line Business Practice Location Address:
561 E 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07504-1862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-640-5428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2016