Provider First Line Business Practice Location Address:
148 SOUTH 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:
07114-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-589-9192
Provider Business Practice Location Address Fax Number:
973-589-6686
Provider Enumeration Date:
10/20/2006