Provider First Line Business Practice Location Address:
1024 EAST JERSEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-353-5920
Provider Business Practice Location Address Fax Number:
908-353-3557
Provider Enumeration Date:
08/09/2006