Provider First Line Business Practice Location Address:
234 FERRY ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-589-7772
Provider Business Practice Location Address Fax Number:
973-589-8228
Provider Enumeration Date:
01/23/2007