Provider First Line Business Practice Location Address:
1606 WELLINGTON AVE UNIT C
Provider Second Line Business Practice Location Address:
COMMUNITY SUPPORT PROFESSIONALS, LLC
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-7704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-799-4505
Provider Business Practice Location Address Fax Number:
910-799-4345
Provider Enumeration Date:
06/12/2013