Provider First Line Business Practice Location Address:
200 HOSPITAL DR STE LLS23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-847-4924
Provider Business Practice Location Address Fax Number:
248-479-1900
Provider Enumeration Date:
10/28/2026