Provider First Line Business Practice Location Address:
2401 LIBERTY HEIGHTS AVE
Provider Second Line Business Practice Location Address:
1080
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-8019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-578-1515
Provider Business Practice Location Address Fax Number:
410-462-1795
Provider Enumeration Date:
12/20/2007