Provider First Line Business Practice Location Address:
HOLY NAME
Provider Second Line Business Practice Location Address:
718 TEANECK ROAD
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-379-5610
Provider Business Practice Location Address Fax Number:
201-379-5611
Provider Enumeration Date:
11/24/2006