Provider First Line Business Practice Location Address:
4717 FALLS ROAD
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:
21209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-0022
Provider Business Practice Location Address Fax Number:
410-366-0322
Provider Enumeration Date:
08/04/2006