Provider First Line Business Practice Location Address:
1275 W GRANADA BLVD. STE 3A
Provider Second Line Business Practice Location Address:
COASTAL PEDIATRICS LLC
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-672-1490
Provider Business Practice Location Address Fax Number:
386-672-1682
Provider Enumeration Date:
11/14/2008