Provider First Line Business Practice Location Address:
458 SOUTH ELRINO STREET
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:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-633-2222
Provider Business Practice Location Address Fax Number:
410-633-5011
Provider Enumeration Date:
09/28/2006