Provider First Line Business Practice Location Address:
DEMATHA HIGH SCHOOL
Provider Second Line Business Practice Location Address:
4313 MADISON ST.
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-864-3666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006