Provider First Line Business Practice Location Address:
121-123 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMITSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-409-3486
Provider Business Practice Location Address Fax Number:
240-559-0949
Provider Enumeration Date:
06/22/2006