Provider First Line Business Practice Location Address:
111 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SMMC, EMPLOYEE HEALTH - MSH ROOM 203
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-877-5452
Provider Business Practice Location Address Fax Number:
973-877-5454
Provider Enumeration Date:
01/16/2007