Provider First Line Business Practice Location Address:
963 ROUTE 9 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-312-5235
Provider Business Practice Location Address Fax Number:
973-512-4202
Provider Enumeration Date:
03/21/2014