Provider First Line Business Practice Location Address:
320 PENNINGTON ST
Provider Second Line Business Practice Location Address:
320 PENNIGTON ST
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07202-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-567-9397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2026