Provider First Line Business Practice Location Address:
ROUTE 72
Provider Second Line Business Practice Location Address:
NEW LISBON DEVELOPMENTAL CENTER, ATTN DENTAL DEPARTMENT
Provider Business Practice Location Address City Name:
NEW LISBON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-726-1000
Provider Business Practice Location Address Fax Number:
609-726-1256
Provider Enumeration Date:
12/18/2012