Provider First Line Business Practice Location Address:
5121 EASTERN AVE
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:
21224-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-633-8787
Provider Business Practice Location Address Fax Number:
410-633-8789
Provider Enumeration Date:
02/19/2008