Provider First Line Business Practice Location Address:
3340 BERT KOONTZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANEYTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21787-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-340-1661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026