Provider First Line Business Practice Location Address:
2500 W NORTH 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:
21216-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-951-4188
Provider Business Practice Location Address Fax Number:
410-951-6158
Provider Enumeration Date:
04/14/2010