Provider First Line Business Practice Location Address:
11152 FALLS ROAD
Provider Second Line Business Practice Location Address:
DEPT. OF ATHLETICS--TRAINING ROOM
Provider Business Practice Location Address City Name:
BROOKLANDVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-821-3039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005