Provider First Line Business Practice Location Address: 
118 COLUMBIA TPKE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FLORHAM PARK
    Provider Business Practice Location Address State Name: 
NJ
    Provider Business Practice Location Address Postal Code: 
07932-2106
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
973-514-2000
    Provider Business Practice Location Address Fax Number: 
973-514-1114
    Provider Enumeration Date: 
06/20/2005