Provider First Line Business Practice Location Address:
697 VALLEY ST.
Provider Second Line Business Practice Location Address:
SUITE B2 WELLSPRING HEALTH COLLECTIVE
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07040-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-596-6385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2009