Provider First Line Business Practice Location Address:
382 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-742-8186
Provider Business Practice Location Address Fax Number:
973-742-8187
Provider Enumeration Date:
08/29/2006