Provider First Line Business Practice Location Address:
CENTER 4 CLEAN START
Provider Second Line Business Practice Location Address:
1001 LAKE STREET
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-742-3460
Provider Business Practice Location Address Fax Number:
410-742-5810
Provider Enumeration Date:
01/14/2008