Provider First Line Business Practice Location Address:
273 NEWARK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-200-6002
Provider Business Practice Location Address Fax Number:
201-984-0607
Provider Enumeration Date:
01/31/2012