Provider First Line Business Practice Location Address:
2400 LIBERTY HEIGHTS AVE
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:
21215-7901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-793-4853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009