Provider First Line Business Practice Location Address:
112 MORRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERALSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21632-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-479-1320
Provider Business Practice Location Address Fax Number:
410-479-3098
Provider Enumeration Date:
08/24/2006