Provider First Line Business Practice Location Address:
3322 FREDERICK 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:
21229-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-566-2080
Provider Business Practice Location Address Fax Number:
410-566-6379
Provider Enumeration Date:
08/03/2006