Provider First Line Business Practice Location Address:
655 E JERSEY ST.
Provider Second Line Business Practice Location Address:
MONASTERY BLDG
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-994-7207
Provider Business Practice Location Address Fax Number:
908-994-7503
Provider Enumeration Date:
07/01/2024