Provider First Line Business Practice Location Address:
1314 BEDFORD AVE
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:
21208-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-602-0555
Provider Business Practice Location Address Fax Number:
410-602-1776
Provider Enumeration Date:
09/25/2006