Provider First Line Business Practice Location Address:
1809 JOHN F. KENNEDY BLVD.
Provider Second Line Business Practice Location Address:
GROUND 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:
07305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-763-6664
Provider Business Practice Location Address Fax Number:
201-763-6840
Provider Enumeration Date:
11/29/2006