Provider First Line Business Practice Location Address:
305 HOSPITAL DR
Provider Second Line Business Practice Location Address:
TATE CENTER, LOWER LEVEL
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-787-4675
Provider Business Practice Location Address Fax Number:
410-595-1906
Provider Enumeration Date:
09/15/2009