Provider First Line Business Practice Location Address:
6830 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-391-6131
Provider Business Practice Location Address Fax Number:
410-391-6144
Provider Enumeration Date:
06/19/2007