Provider First Line Business Practice Location Address:
35 QUITMAN ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-295-5380
Provider Business Practice Location Address Fax Number:
973-497-7082
Provider Enumeration Date:
07/29/2010