Provider First Line Business Practice Location Address:
111-115 GATES AVE
Provider Second Line Business Practice Location Address:
REHAB DEPARTMENT
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-239-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2007