Provider First Line Business Practice Location Address:
1314 BEDFORD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-0999
Provider Business Practice Location Address Fax Number:
410-602-1776
Provider Enumeration Date:
11/27/2006