Provider First Line Business Practice Location Address:
142 ALLENDALE ST
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:
21229-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-808-5258
Provider Business Practice Location Address Fax Number:
443-682-8260
Provider Enumeration Date:
08/21/2015