Provider First Line Business Practice Location Address:
571 BROAD STREET
Provider Second Line Business Practice Location Address:
YEN LONGOBARDI
Provider Business Practice Location Address City Name:
CENTRAL FALLS
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-724-9882
Provider Business Practice Location Address Fax Number:
401-724-9882
Provider Enumeration Date:
12/11/2006