Provider First Line Business Practice Location Address:
643 645 MT PROSPECT AVE 1ST FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-484-5607
Provider Business Practice Location Address Fax Number:
973-484-6958
Provider Enumeration Date:
01/16/2007