Provider First Line Business Practice Location Address:
3422 BELAIR RD
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21213-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-483-7357
Provider Business Practice Location Address Fax Number:
410-483-7359
Provider Enumeration Date:
12/13/2007