Provider First Line Business Practice Location Address:
532 MCKINLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-383-6823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2026