Provider First Line Business Practice Location Address:
253 GREENDELL ROAD
Provider Second Line Business Practice Location Address:
FRELINGHUYSEN COMMUNITY RESIDENCE (STATE)
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-850-5181
Provider Business Practice Location Address Fax Number:
908-850-1459
Provider Enumeration Date:
06/19/2015