Provider First Line Business Practice Location Address:
603 LACKAWANNA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-237-6222
Provider Business Practice Location Address Fax Number:
973-237-6223
Provider Enumeration Date:
07/06/2007