Provider First Line Business Practice Location Address:
669 ELIZABETH AVE
Provider Second Line Business Practice Location Address:
LYONS MEDICAL CENTER UC
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-923-6452
Provider Business Practice Location Address Fax Number:
973-923-1979
Provider Enumeration Date:
09/01/2006