Provider First Line Business Practice Location Address:
6028 BROADWAY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SPECIAL SERVICES
Provider Business Practice Location Address City Name:
WEST NEW YORK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-553-4000
Provider Business Practice Location Address Fax Number:
201-902-2299
Provider Enumeration Date:
04/26/2007