Provider First Line Business Practice Location Address:
6133 SHADY SIDE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHADY SIDE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-867-0247
Provider Business Practice Location Address Fax Number:
410-867-0248
Provider Enumeration Date:
07/27/2006