Provider First Line Business Practice Location Address:
5233 KING AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-574-3100
Provider Business Practice Location Address Fax Number:
410-574-3710
Provider Enumeration Date:
07/19/2007