Provider First Line Business Practice Location Address:
316-20TH ST.(MONASTERY PL)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-866-8626
Provider Business Practice Location Address Fax Number:
201-866-2556
Provider Enumeration Date:
12/27/2006