Provider First Line Business Practice Location Address:
124 E BALTIMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-739-7748
Provider Business Practice Location Address Fax Number:
304-739-4001
Provider Enumeration Date:
03/05/2014