Provider First Line Business Practice Location Address:
1400 N ALBANY AVE
Provider Second Line Business Practice Location Address:
ATLANTIC CITY TEEN CENTER AT ATLANTIC CITY HIGH SCHOOL
Provider Business Practice Location Address City Name:
ATLANTIC CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08401-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-645-7601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006