Provider First Line Business Practice Location Address:
448 N LUZERNE 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:
21224-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-675-3394
Provider Business Practice Location Address Fax Number:
410-675-8056
Provider Enumeration Date:
04/09/2007