Provider First Line Business Practice Location Address:
230 W JERSEY ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07202-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-994-1414
Provider Business Practice Location Address Fax Number:
908-994-1474
Provider Enumeration Date:
12/01/2006