Provider First Line Business Practice Location Address:
627 ELIZABETH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-354-0030
Provider Business Practice Location Address Fax Number:
908-354-4029
Provider Enumeration Date:
09/11/2006