Provider First Line Business Practice Location Address:
510 31ST STREET
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-866-3322
Provider Business Practice Location Address Fax Number:
201-866-2289
Provider Enumeration Date:
06/29/2006