Provider First Line Business Practice Location Address:
82 PARK AVE
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:
07501-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-881-8568
Provider Business Practice Location Address Fax Number:
973-881-9333
Provider Enumeration Date:
10/24/2005