Provider First Line Business Practice Location Address:
3506 N CALVERT ST
Provider Second Line Business Practice Location Address:
SUITE #110
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-889-5252
Provider Business Practice Location Address Fax Number:
410-889-6102
Provider Enumeration Date:
10/08/2008