Provider First Line Business Practice Location Address:
148 CLENDENNY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07304-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-616-2201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2026