Provider First Line Business Practice Location Address:
130 WHITE HORSE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEMENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08021-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-9101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2007