Provider First Line Business Practice Location Address:
52 OBERT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08882-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-266-6545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2025