Provider First Line Business Practice Location Address:
98 MIRACLE STRIP PKWY #205
Provider Second Line Business Practice Location Address:
CROSSROADS COUNSELING CENTER
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-796-7200
Provider Business Practice Location Address Fax Number:
850-796-7251
Provider Enumeration Date:
08/30/2006