Provider First Line Business Practice Location Address:
3004 ESSEX ROAD
Provider Second Line Business Practice Location Address:
ATTN: REHABILITATION MANAGER
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-643-1200
Provider Business Practice Location Address Fax Number:
410-204-7237
Provider Enumeration Date:
05/16/2006