Provider First Line Business Practice Location Address:
237 HALSEY ST
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:
07102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-955-2285
Provider Business Practice Location Address Fax Number:
862-367-8219
Provider Enumeration Date:
07/01/2022