Provider First Line Business Practice Location Address:
VA MEDICAL CENTER C/O MENTAL HEALTH SERVICE LINE #116
Provider Second Line Business Practice Location Address:
AVE D. BUILDING 364
Provider Business Practice Location Address City Name:
PERRYVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-642-2411
Provider Business Practice Location Address Fax Number:
410-642-1707
Provider Enumeration Date:
09/08/2006