Provider First Line Business Practice Location Address:
130 WAYNE AVE UNIT 2
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:
07502-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-456-3103
Provider Business Practice Location Address Fax Number:
718-433-9002
Provider Enumeration Date:
06/02/2021