Provider First Line Business Practice Location Address:
93 E 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07513-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-881-1191
Provider Business Practice Location Address Fax Number:
973-807-1844
Provider Enumeration Date:
05/30/2023