Provider First Line Business Practice Location Address:
121 DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112-1357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-536-6462
Provider Business Practice Location Address Fax Number:
973-242-9339
Provider Enumeration Date:
01/11/2018