Provider First Line Business Practice Location Address:
827 LINDEN 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:
21201-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-7605
Provider Business Practice Location Address Fax Number:
410-328-7607
Provider Enumeration Date:
04/09/2009