Provider First Line Business Practice Location Address:
235 DAKOTA ST. UNIT 1
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:
07503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-930-3227
Provider Business Practice Location Address Fax Number:
973-341-4204
Provider Enumeration Date:
07/28/2017