Provider First Line Business Practice Location Address:
152 DUMBARTON RD
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:
21212-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-2546
Provider Business Practice Location Address Fax Number:
415-554-6899
Provider Enumeration Date:
12/14/2006