Provider First Line Business Practice Location Address:
142 PALISADE AVE
Provider Second Line Business Practice Location Address:
DOCTORS OFFICE BLDG. SUITE 108
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-795-0101
Provider Business Practice Location Address Fax Number:
201-795-3550
Provider Enumeration Date:
01/27/2012