Provider First Line Business Practice Location Address:
124 SLADE AVE
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-764-0330
Provider Business Practice Location Address Fax Number:
410-764-0356
Provider Enumeration Date:
11/18/2009