Provider First Line Business Practice Location Address:
561 IRVINGTON AVE
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:
07106-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-373-0387
Provider Business Practice Location Address Fax Number:
973-399-2614
Provider Enumeration Date:
11/22/2011