Provider First Line Business Practice Location Address: 
322 WEST CARROLL STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SALISBURY
    Provider Business Practice Location Address State Name: 
MD
    Provider Business Practice Location Address Postal Code: 
21801
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
410-860-8446
    Provider Business Practice Location Address Fax Number: 
410-548-4119
    Provider Enumeration Date: 
04/07/2006