Provider First Line Business Practice Location Address:
44 LAKESIDE AVE
Provider Second Line Business Practice Location Address:
POMPTON LAKES HIGH SCHOOL
Provider Business Practice Location Address City Name:
POMPTON LAKES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-835-7100
Provider Business Practice Location Address Fax Number:
973-835-1054
Provider Enumeration Date:
04/26/2007