Provider First Line Business Practice Location Address:
70 WEST ALLENDALE AV
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-327-5642
Provider Business Practice Location Address Fax Number:
201-327-0659
Provider Enumeration Date:
12/26/2006