Provider First Line Business Practice Location Address:
10231 OLD OCEAN CITY BLVD
Provider Second Line Business Practice Location Address:
STE 103, JAMES G. BARRETT MEDICAL BLDG
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-629-0071
Provider Business Practice Location Address Fax Number:
410-629-0081
Provider Enumeration Date:
04/26/2007