Provider First Line Business Practice Location Address:
30 PROSPECT AVE, 60 2ND ST #1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-996-3492
Provider Business Practice Location Address Fax Number:
551-996-0530
Provider Enumeration Date:
03/25/2024