Provider First Line Business Practice Location Address:
24 NEWBOLD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-517-6124
Provider Business Practice Location Address Fax Number:
570-517-6124
Provider Enumeration Date:
07/24/2025