Provider First Line Business Practice Location Address:
2840 SIXTH AVENUE SOUTH
Provider Second Line Business Practice Location Address:
THE CHILDRENS PLACE AT HOME SALE
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-433-0060
Provider Business Practice Location Address Fax Number:
561-832-4786
Provider Enumeration Date:
04/26/2007