Provider First Line Business Practice Location Address:
1070 S WICKHAM ROAD
Provider Second Line Business Practice Location Address:
SPACE COAST CHIROPRACTIC INC
Provider Business Practice Location Address City Name:
WEST MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-729-9000
Provider Business Practice Location Address Fax Number:
321-722-3997
Provider Enumeration Date:
03/22/2007