Provider First Line Business Practice Location Address:
183 S ORANGE AVE
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:
07018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-1232
Provider Business Practice Location Address Fax Number:
973-972-0845
Provider Enumeration Date:
10/03/2012