Provider First Line Business Practice Location Address:
245 PROSPECT AVE
Provider Second Line Business Practice Location Address:
LPC
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-208-5201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2013