Provider First Line Business Practice Location Address:
393-395 SOUTH ORANGE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-622-4500
Provider Business Practice Location Address Fax Number:
973-622-4504
Provider Enumeration Date:
03/24/2008