Provider First Line Business Practice Location Address:
5158 BLACK HAWK RD
Provider Second Line Business Practice Location Address:
CTR FOR HEALTH PROMOTION & PREVENTIVE MEDICINE
Provider Business Practice Location Address City Name:
ABERDEEN PROVING GROUND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21010-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-436-1991
Provider Business Practice Location Address Fax Number:
410-436-4117
Provider Enumeration Date:
11/04/2005