Provider First Line Business Practice Location Address:
4200 EDMONDSON AVE
Provider Second Line Business Practice Location Address:
SUITE 202B
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-947-0433
Provider Business Practice Location Address Fax Number:
410-945-5393
Provider Enumeration Date:
04/23/2007