Provider First Line Business Practice Location Address:
1521 HARFORD 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:
21202-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-962-5541
Provider Business Practice Location Address Fax Number:
410-962-7108
Provider Enumeration Date:
04/06/2011