Provider First Line Business Practice Location Address:
134 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE FERRY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07643-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-641-9119
Provider Business Practice Location Address Fax Number:
201-641-2664
Provider Enumeration Date:
08/03/2006