Provider First Line Business Practice Location Address:
163 ROSA PARKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-345-5853
Provider Business Practice Location Address Fax Number:
973-345-1649
Provider Enumeration Date:
10/26/2007