Provider First Line Business Practice Location Address:
4419 FALLS ROAD
Provider Second Line Business Practice Location Address:
FALLS LANE MEDICAL CENTER STE E
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-1226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-578-0336
Provider Business Practice Location Address Fax Number:
410-361-0651
Provider Enumeration Date:
03/06/2007