Provider First Line Business Practice Location Address:
608 21ST AVE
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:
07513-1261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-931-7823
Provider Business Practice Location Address Fax Number:
973-279-4933
Provider Enumeration Date:
12/31/2013