Provider First Line Business Practice Location Address:
151 48TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07089-6427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-223-2308
Provider Business Practice Location Address Fax Number:
201-223-2293
Provider Enumeration Date:
12/24/2009