Provider First Line Business Practice Location Address: 
VAMC PERRY POINT
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PERRY POINT
    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: 
09/15/2006