Provider First Line Business Practice Location Address:
590 NEWARK AVE.
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-984-2294
Provider Business Practice Location Address Fax Number:
201-398-0029
Provider Enumeration Date:
11/11/2009