Provider First Line Business Practice Location Address:
6237 BERKELEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21209-3944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-698-8804
Provider Business Practice Location Address Fax Number:
410-764-1493
Provider Enumeration Date:
09/20/2005