Provider First Line Business Practice Location Address:
140 42 FERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-344-2982
Provider Business Practice Location Address Fax Number:
973-344-4630
Provider Enumeration Date:
08/23/2017