Provider First Line Business Practice Location Address:
THE WELLSPRING CENTER
Provider Second Line Business Practice Location Address:
658 BOULTON ST.
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-836-9622
Provider Business Practice Location Address Fax Number:
410-836-9632
Provider Enumeration Date:
09/21/2006