Provider First Line Business Practice Location Address:
164 FERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-589-5227
Provider Business Practice Location Address Fax Number:
973-589-5405
Provider Enumeration Date:
09/03/2017