Provider First Line Business Practice Location Address:
3721 POTEE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21225-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-355-7725
Provider Business Practice Location Address Fax Number:
410-355-4084
Provider Enumeration Date:
04/07/2007