Provider First Line Business Practice Location Address:
588 E 27TH ST
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:
07504-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-345-3329
Provider Business Practice Location Address Fax Number:
973-742-6664
Provider Enumeration Date:
12/24/2007