Provider First Line Business Practice Location Address:
1100 WOODBRIDGE AVE
Provider Second Line Business Practice Location Address:
EAST JERSEY STATE PRISON
Provider Business Practice Location Address City Name:
EVENEL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-381-3504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2008