Provider First Line Business Practice Location Address:
55 WADE AVENUE
Provider Second Line Business Practice Location Address:
SPRING GROVE HOSPITAL CENTER
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-402-7486
Provider Business Practice Location Address Fax Number:
410-402-7094
Provider Enumeration Date:
03/08/2007