Provider First Line Business Practice Location Address:
313 SOUTH AVE
Provider Second Line Business Practice Location Address:
SUITE #205 PANTHER PT AND SPORTS MEDICINE
Provider Business Practice Location Address City Name:
FANWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-889-7900
Provider Business Practice Location Address Fax Number:
908-889-6003
Provider Enumeration Date:
10/17/2006