Provider First Line Business Practice Location Address:
7800 HOUSE OF CORRECTION ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JESSUP
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-664-2560
Provider Business Practice Location Address Fax Number:
410-664-2560
Provider Enumeration Date:
10/31/2008