Provider First Line Business Practice Location Address:
3106 E NORTHERN PKWY
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:
21214-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-444-9999
Provider Business Practice Location Address Fax Number:
410-444-9995
Provider Enumeration Date:
09/02/2009