Provider First Line Business Practice Location Address:
19 WALKER AVE STE 202
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:
21208-4078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-580-1220
Provider Business Practice Location Address Fax Number:
410-520-1226
Provider Enumeration Date:
02/27/2007