Provider First Line Business Practice Location Address:
3832 THE ALAMEDA
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:
21218-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-478-9156
Provider Business Practice Location Address Fax Number:
443-218-8134
Provider Enumeration Date:
04/13/2012