Provider First Line Business Practice Location Address:
201 LYONS AVE
Provider Second Line Business Practice Location Address:
TLC- OUTPATIENT PROGRAM
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-926-7812
Provider Business Practice Location Address Fax Number:
973-926-2943
Provider Enumeration Date:
03/19/2020