Provider First Line Business Practice Location Address:
96 W ALLENDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07401-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-698-8137
Provider Business Practice Location Address Fax Number:
732-283-4020
Provider Enumeration Date:
07/23/2013