Provider First Line Business Practice Location Address:
400 PASSAIC AVE
Provider Second Line Business Practice Location Address:
APT 112
Provider Business Practice Location Address City Name:
EAST NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07029-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-575-0070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007