Provider First Line Business Practice Location Address:
85-99 HAZEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-333-3199
Provider Business Practice Location Address Fax Number:
973-968-6333
Provider Enumeration Date:
12/27/2023