Provider First Line Business Practice Location Address:
1390 OLD INDIAN MILLS ROAD
Provider Second Line Business Practice Location Address:
SHAMONG ROAD GROUP HOME
Provider Business Practice Location Address City Name:
SHAMONG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-267-5928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2014