Provider First Line Business Practice Location Address:
5624 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY STORE 374
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-719-7608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2011