Provider First Line Business Practice Location Address:
110 BERGEN ST
Provider Second Line Business Practice Location Address:
UMDNJ - NEW JERSEY DENTAL SCHOOL
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-0833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007