Provider First Line Business Practice Location Address:
190 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07439-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-827-1646
Provider Business Practice Location Address Fax Number:
973-827-1646
Provider Enumeration Date:
11/15/2006