Provider First Line Business Practice Location Address:
3101 TOWANDA 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:
21215-7827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-4942
Provider Business Practice Location Address Fax Number:
410-383-4513
Provider Enumeration Date:
10/03/2007