Provider First Line Business Practice Location Address:
223 MONMOUTH ROAD
Provider Second Line Business Practice Location Address:
PEDIATRIC & ADOLESCENT MEDICINE PA
Provider Business Practice Location Address City Name:
W LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-229-4540
Provider Business Practice Location Address Fax Number:
732-229-8689
Provider Enumeration Date:
04/14/2006