Provider First Line Business Practice Location Address:
550 MOUNT PROSPECT AVE
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:
07104-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-482-4697
Provider Business Practice Location Address Fax Number:
973-482-0893
Provider Enumeration Date:
05/19/2008