Provider First Line Business Practice Location Address:
309B 48TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-553-0022
Provider Business Practice Location Address Fax Number:
201-553-0023
Provider Enumeration Date:
01/22/2007