Provider First Line Business Practice Location Address:
RT. 72 EAST
Provider Second Line Business Practice Location Address:
NEW LISBON DEVELOPMENTAL CENTER
Provider Business Practice Location Address City Name:
NEW LISBON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-726-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006