Provider First Line Business Practice Location Address:
4909 LIBERTY HEIGHTS AVENUE
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:
21207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-426-1601
Provider Business Practice Location Address Fax Number:
443-272-1757
Provider Enumeration Date:
01/09/2013