Provider First Line Business Practice Location Address:
209 W PATRICK ST
Provider Second Line Business Practice Location Address:
CITY PARK PSYCH SVCS, LLC
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-5515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-401-2813
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2006