Provider First Line Business Practice Location Address:
3196 KENNEDY BLVD.
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-222-8700
Provider Business Practice Location Address Fax Number:
908-222-8721
Provider Enumeration Date:
09/28/2026