Provider First Line Business Practice Location Address:
220 RONNIE CT COASTAL HAVEN COUNSELING
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
943-945-0346
Provider Business Practice Location Address Fax Number:
856-881-7614
Provider Enumeration Date:
09/17/2010