Provider First Line Business Practice Location Address:
196 JEWETT AVENUE
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:
07304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-332-3354
Provider Business Practice Location Address Fax Number:
201-332-0180
Provider Enumeration Date:
05/01/2006