Provider First Line Business Practice Location Address:
4863 PULASKI HWY
Provider Second Line Business Practice Location Address:
STE 100 PRINCIPIO HEALTH CENTER
Provider Business Practice Location Address City Name:
PERRYVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-398-4679
Provider Business Practice Location Address Fax Number:
410-620-3686
Provider Enumeration Date:
01/26/2009