Provider First Line Business Practice Location Address:
703 MAIN ST
Provider Second Line Business Practice Location Address:
ST. JOSEPH'S CHILDREN'S HOSPITAL- RM X609
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-2535
Provider Business Practice Location Address Fax Number:
973-754-3389
Provider Enumeration Date:
12/26/2008