Provider First Line Business Practice Location Address:
185 S ORANGE AVE
Provider Second Line Business Practice Location Address:
UNIVERSITY HEALTH SCIENCES BLD, RM C-636
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-3728
Provider Business Practice Location Address Fax Number:
973-972-0045
Provider Enumeration Date:
01/16/2013