Provider First Line Business Practice Location Address:
74 E ALLENDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07401-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-825-1835
Provider Business Practice Location Address Fax Number:
201-818-5012
Provider Enumeration Date:
03/28/2008