Provider First Line Business Practice Location Address:
COASTAL CAROLINA NEUROPSYCHIATRIC CENTER
Provider Second Line Business Practice Location Address:
200 TARPON TRAIL
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-938-1114
Provider Business Practice Location Address Fax Number:
910-938-1118
Provider Enumeration Date:
11/16/2005