Provider First Line Business Practice Location Address:
1419 KNECHT 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:
21227-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-778-4066
Provider Business Practice Location Address Fax Number:
615-778-9114
Provider Enumeration Date:
03/23/2007