Provider First Line Business Practice Location Address:
588 NEWARK AVE RM B84
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-334-6599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2024