Provider First Line Business Practice Location Address:
236 ROSEBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-859-4311
Provider Business Practice Location Address Fax Number:
908-859-4499
Provider Enumeration Date:
06/16/2006