Provider First Line Business Practice Location Address:
3 THEATRE CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-729-3722
Provider Business Practice Location Address Fax Number:
570-296-2043
Provider Enumeration Date:
03/08/2007