Provider First Line Business Practice Location Address:
3501 TANEY RD
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:
21215-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-424-7846
Provider Business Practice Location Address Fax Number:
443-817-0491
Provider Enumeration Date:
12/31/2007