Provider First Line Business Practice Location Address:
242 10TH ST
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:
07302-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-795-2499
Provider Business Practice Location Address Fax Number:
201-795-3579
Provider Enumeration Date:
02/19/2007