Provider First Line Business Practice Location Address:
562 E 23RD 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:
07514-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-425-8851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2025