Provider First Line Business Practice Location Address:
4419 FALLS RD
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-1226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-467-8444
Provider Business Practice Location Address Fax Number:
410-879-2096
Provider Enumeration Date:
07/05/2006