Provider First Line Business Practice Location Address:
22 TERRACE AVE UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07307-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-924-7792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2026