Provider First Line Business Practice Location Address:
201 LYONS AVE AT OSBORNE TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-926-3518
Provider Business Practice Location Address Fax Number:
973-926-9568
Provider Enumeration Date:
07/10/2006