Provider First Line Business Practice Location Address:
417 E BALTIMORE ST
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
TANEYTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21787-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-756-5240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2006