Provider First Line Business Practice Location Address:
537 MOUNTAIN AVENUE
Provider Second Line Business Practice Location Address:
ATTN: EXTENDED CARE ADMINSTRATOR
Provider Business Practice Location Address City Name:
NEW PROVIDENCE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-516-9400
Provider Business Practice Location Address Fax Number:
410-204-7237
Provider Enumeration Date:
01/24/2017