Provider First Line Business Practice Location Address:
BATES BUILDING 2ND FLOOR WHITTLESEY ROAD
Provider Second Line Business Practice Location Address:
UCHC C/O NJDOC
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-459-7000
Provider Business Practice Location Address Fax Number:
856-459-8713
Provider Enumeration Date:
05/17/2007