Provider First Line Business Practice Location Address:
1401 LAUREL OAK RD
Provider Second Line Business Practice Location Address:
EASTERN HIGH SCHOOL
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-784-4441
Provider Business Practice Location Address Fax Number:
856-784-1322
Provider Enumeration Date:
05/03/2006