Provider First Line Business Practice Location Address:
2524 KIRK AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-4826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-467-6040
Provider Business Practice Location Address Fax Number:
410-235-8807
Provider Enumeration Date:
03/28/2008