Provider First Line Business Practice Location Address:
1400 SULPHURSPRING 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:
21227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-737-9221
Provider Business Practice Location Address Fax Number:
410-646-2327
Provider Enumeration Date:
09/08/2010