Provider First Line Business Practice Location Address:
14000 JERICHO PARK ROAD
Provider Second Line Business Practice Location Address:
HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-860-4170
Provider Business Practice Location Address Fax Number:
601-860-4179
Provider Enumeration Date:
02/27/2019