Provider First Line Business Practice Location Address:
523 HARWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-532-8477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2009