Provider First Line Business Practice Location Address:
133 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FROSTBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21532-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-284-2238
Provider Business Practice Location Address Fax Number:
240-284-2852
Provider Enumeration Date:
09/19/2019