Provider First Line Business Practice Location Address:
1947 KENNEDY BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-433-4848
Provider Business Practice Location Address Fax Number:
201-946-9292
Provider Enumeration Date:
11/20/2006