Provider First Line Business Practice Location Address:
1434 PORTER ST
Provider Second Line Business Practice Location Address:
BARQUIST CLINC, FT DETRICK
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-9254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-619-8096
Provider Business Practice Location Address Fax Number:
301-619-2064
Provider Enumeration Date:
03/07/2007