Provider First Line Business Practice Location Address: 
AVENUE D & 8TH ST
    Provider Second Line Business Practice Location Address: 
PERRY POINT VA MEDICASL CENTER
    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: 
    Provider Enumeration Date: 
06/13/2017