Provider First Line Business Practice Location Address:
EAST JERSEY STATE PRISON
Provider Second Line Business Practice Location Address:
LOCKBAG R
Provider Business Practice Location Address City Name:
RAHWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-396-0492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2008