Provider First Line Business Practice Location Address:
512 PORT ST. LUCIE BLVD.
Provider Second Line Business Practice Location Address:
LEGACY BEHAVIORAL HEALTH CENTER, INC.
Provider Business Practice Location Address City Name:
PORT ST. LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-873-8811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2012