Provider First Line Business Practice Location Address:
485-491 MT PROSPECT AVE 1ST FLOOR
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:
07104-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-485-6433
Provider Business Practice Location Address Fax Number:
973-675-0040
Provider Enumeration Date:
01/29/2020