Provider First Line Business Practice Location Address:
1433 PORTER ST
Provider Second Line Business Practice Location Address:
FORT DETRICK ARMY GARRISON
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-9211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-624-1200
Provider Business Practice Location Address Fax Number:
240-379-7013
Provider Enumeration Date:
06/13/2006