Provider First Line Business Practice Location Address:
213 WASHINGTON ST
Provider Second Line Business Practice Location Address:
NJ-02-02-02
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-802-6398
Provider Business Practice Location Address Fax Number:
973-802-3182
Provider Enumeration Date:
05/08/2007