Provider First Line Business Practice Location Address:
111 WASHINTON STREET
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-403-9300
Provider Business Practice Location Address Fax Number:
201-521-4325
Provider Enumeration Date:
05/01/2017