Provider First Line Business Practice Location Address:
8450 DORSEY RUN RD
Provider Second Line Business Practice Location Address:
C.T. PERKINS HOSPITAL CENTER
Provider Business Practice Location Address City Name:
JESSUP
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20794-9486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-724-3150
Provider Business Practice Location Address Fax Number:
410-724-3159
Provider Enumeration Date:
09/30/2005