Provider First Line Business Practice Location Address:
79 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-827-8801
Provider Business Practice Location Address Fax Number:
973-827-1942
Provider Enumeration Date:
08/07/2006