Provider First Line Business Practice Location Address:
4295 RT 47
Provider Second Line Business Practice Location Address:
SOUTHERN STATE CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
DELMONT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-785-1300
Provider Business Practice Location Address Fax Number:
856-785-2074
Provider Enumeration Date:
03/06/2008