Provider First Line Business Practice Location Address:
419 KNICKERBOCKER AVE
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:
07503-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-888-2210
Provider Business Practice Location Address Fax Number:
973-478-9169
Provider Enumeration Date:
09/29/2014