Provider First Line Business Practice Location Address:
480 S 13TH ST
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:
07103-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-565-1233
Provider Business Practice Location Address Fax Number:
973-565-0044
Provider Enumeration Date:
02/05/2014