Provider First Line Business Practice Location Address:
1718 BELMONT AVE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21244-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-265-9292
Provider Business Practice Location Address Fax Number:
410-265-9295
Provider Enumeration Date:
07/07/2005