Provider First Line Business Practice Location Address:
SITE OFFICE: CHARLES CARROLL MS 6130 LAMONT DRIVE
Provider Second Line Business Practice Location Address:
C/O MS. CLAUDIA B.-WALTER, FBCOG- CEO FOR SON RISE CC&I
Provider Business Practice Location Address City Name:
NEW CARROLLTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-458-0578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2018