Provider First Line Business Practice Location Address:
18 HOUNDSWOOD CT
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:
21209-1067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-722-5511
Provider Business Practice Location Address Fax Number:
503-210-0453
Provider Enumeration Date:
11/26/2010