Provider First Line Business Practice Location Address:
590 NEWARK AVE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-420-1165
Provider Business Practice Location Address Fax Number:
201-420-6893
Provider Enumeration Date:
07/20/2007