Provider First Line Business Practice Location Address:
615 SHIPYARD BLVD.
Provider Second Line Business Practice Location Address:
COASTAL HORIZONS CENTER INC.
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-343-0145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007