Provider First Line Business Practice Location Address:
1245 EASTERN BLVD
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:
21221-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-4700
Provider Business Practice Location Address Fax Number:
410-780-0364
Provider Enumeration Date:
07/12/2005