Provider First Line Business Practice Location Address:
192 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-996-0232
Provider Business Practice Location Address Fax Number:
201-996-0095
Provider Enumeration Date:
10/27/2006