Provider First Line Business Practice Location Address:
138-162 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-5369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-931-5078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2023