Provider First Line Business Practice Location Address:
138 DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-388-4672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2024