Provider First Line Business Practice Location Address:
4710 PENNINGTON AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR, SUITE 3
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21226-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-254-4343
Provider Business Practice Location Address Fax Number:
410-254-4342
Provider Enumeration Date:
04/23/2012