Provider First Line Business Practice Location Address:
595 W. GRANADA BLVD.
Provider Second Line Business Practice Location Address:
SUITE E-2 (E. COAST NEUROPSYCHIATRIC)
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:
386-672-4222
Provider Business Practice Location Address Fax Number:
386-672-8855
Provider Enumeration Date:
06/19/2009