Provider First Line Business Practice Location Address:
500 WOODBOURNE 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:
21212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-248-0257
Provider Business Practice Location Address Fax Number:
443-708-4691
Provider Enumeration Date:
04/11/2011