Provider First Line Business Practice Location Address:
136 IVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PLAINFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07080-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-628-5747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2025