Provider First Line Business Practice Location Address:
3720 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-646-0001
Provider Business Practice Location Address Fax Number:
410-646-1600
Provider Enumeration Date:
06/08/2015