Provider First Line Business Practice Location Address:
110 BERGEN STREET, UMDNJ
Provider Second Line Business Practice Location Address:
PEDIATRIC DENTISTRY DEPARTMENT, RM C-722
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-4621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2009