Provider First Line Business Practice Location Address:
7151 HOLABIRD AVE
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:
21222-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-282-3300
Provider Business Practice Location Address Fax Number:
410-282-3333
Provider Enumeration Date:
06/12/2005