Provider First Line Business Practice Location Address:
33 NORTH MAPLE AVENUE
Provider Second Line Business Practice Location Address:
BASKING RIDGE COMMUNITY RESIDENCE
Provider Business Practice Location Address City Name:
BASKING RIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-204-0950
Provider Business Practice Location Address Fax Number:
908-204-1990
Provider Enumeration Date:
06/19/2015