Provider First Line Business Practice Location Address:
827 LINDEN AVENUE
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:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-462-5420
Provider Business Practice Location Address Fax Number:
410-728-1718
Provider Enumeration Date:
10/27/2006