Provider First Line Business Practice Location Address:
296 E KINNEY 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:
07105-5963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-508-8047
Provider Business Practice Location Address Fax Number:
973-344-0919
Provider Enumeration Date:
04/25/2024