Provider First Line Business Practice Location Address:
108-136 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
APT 1312-B
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-5348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-598-4385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2011