Provider First Line Business Practice Location Address: 
2015 EAST WEST HWY
    Provider Second Line Business Practice Location Address: 
FOX CHASE REHAB
    Provider Business Practice Location Address City Name: 
SILVER SPRING
    Provider Business Practice Location Address State Name: 
MD
    Provider Business Practice Location Address Postal Code: 
20902-1817
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
301-987-2400
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/21/2015