Provider First Line Business Practice Location Address:
15120 COUNTY BARN RD
Provider Second Line Business Practice Location Address:
GULF COAST MENTAL HEALTH CENTER CSU UNIT
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-748-4037
Provider Business Practice Location Address Fax Number:
609-652-3573
Provider Enumeration Date:
08/03/2006