Provider First Line Business Practice Location Address:
3428 PARKLAWN 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:
21213-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-325-3428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2006