Provider First Line Business Practice Location Address:
6830 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-238-5390
Provider Business Practice Location Address Fax Number:
410-238-5396
Provider Enumeration Date:
06/15/2011