Provider First Line Business Practice Location Address:
4259 PARK HEIGHTS 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:
21215-6740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-466-8001
Provider Business Practice Location Address Fax Number:
410-466-8304
Provider Enumeration Date:
12/26/2006