Provider First Line Business Practice Location Address:
40 S. DUNDALK 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:
21222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-282-6434
Provider Business Practice Location Address Fax Number:
410-284-4636
Provider Enumeration Date:
10/02/2006