Provider First Line Business Practice Location Address:
14-20 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07017-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-672-2025
Provider Business Practice Location Address Fax Number:
973-675-1381
Provider Enumeration Date:
07/02/2006