Provider First Line Business Practice Location Address:
185 SOUTH ORANGE AVENUE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY, NJ MEDICAL SCHOOL, MSB E-562
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-8235
Provider Business Practice Location Address Fax Number:
973-972-5292
Provider Enumeration Date:
02/14/2008