Provider First Line Business Practice Location Address:
119 1ST ST
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
HO HO KUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07423-1575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-652-7711
Provider Business Practice Location Address Fax Number:
201-652-7350
Provider Enumeration Date:
06/29/2010