Provider First Line Business Practice Location Address:
3716 AND ONE HALF W BELVEREDE AVE
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-367-5628
Provider Business Practice Location Address Fax Number:
410-367-5639
Provider Enumeration Date:
03/19/2007