Provider First Line Business Practice Location Address:
260 JOHN ST
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-841-5397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2013