Provider First Line Business Practice Location Address:
4605 EDMONDSON 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:
21229-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-947-0370
Provider Business Practice Location Address Fax Number:
410-947-0371
Provider Enumeration Date:
04/17/2007