Provider First Line Business Practice Location Address:
155 JEFFERSON ST
Provider Second Line Business Practice Location Address:
MENTAL HEALTH-4W
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-465-2605
Provider Business Practice Location Address Fax Number:
973-465-2829
Provider Enumeration Date:
12/05/2005