Provider First Line Business Practice Location Address:
34 STENGEL AVE SUITE B
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-819-9510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2023