Provider First Line Business Practice Location Address:
14 3RD ST
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:
07107-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-980-9977
Provider Business Practice Location Address Fax Number:
973-566-3677
Provider Enumeration Date:
12/27/2024