Provider First Line Business Practice Location Address:
837 UPPER MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-316-4004
Provider Business Practice Location Address Fax Number:
732-316-4005
Provider Enumeration Date:
02/07/2024