Provider First Line Business Practice Location Address:
3449 WILKENS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-646-5869
Provider Business Practice Location Address Fax Number:
410-646-5869
Provider Enumeration Date:
12/18/2009