Provider First Line Business Practice Location Address:
1716 SULPHUR SPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALETHORPE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-242-0750
Provider Business Practice Location Address Fax Number:
410-242-0751
Provider Enumeration Date:
11/10/2005