Provider First Line Business Practice Location Address: 
1279 US HIGHWAY 46
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PARSIPPANY
    Provider Business Practice Location Address State Name: 
NJ
    Provider Business Practice Location Address Postal Code: 
07054-4904
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
973-334-0577
    Provider Business Practice Location Address Fax Number: 
973-227-2330
    Provider Enumeration Date: 
12/13/2006