Provider First Line Business Practice Location Address:
EDNA MAHAN CORRECTIONAL FACILITY
Provider Second Line Business Practice Location Address:
30 PITTSTOWN RD
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-735-7111
Provider Business Practice Location Address Fax Number:
908-735-6379
Provider Enumeration Date:
05/22/2007