Provider First Line Business Practice Location Address:
210 GUILFORD AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-8615
Provider Business Practice Location Address Fax Number:
410-545-6636
Provider Enumeration Date:
10/26/2006