Provider First Line Business Practice Location Address:
316 N 6TH ST
Provider Second Line Business Practice Location Address:
PROSPECT PARK
Provider Business Practice Location Address City Name:
PROSPECT PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07508-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-904-3875
Provider Business Practice Location Address Fax Number:
973-904-1477
Provider Enumeration Date:
05/18/2007