Provider First Line Business Practice Location Address:
671 MOUNT PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-481-5885
Provider Business Practice Location Address Fax Number:
973-481-5822
Provider Enumeration Date:
02/22/2007