Provider First Line Business Practice Location Address:
1078 E 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07513-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-742-5827
Provider Business Practice Location Address Fax Number:
973-742-8149
Provider Enumeration Date:
09/20/2006