Provider First Line Business Practice Location Address:
4538 EDMONDSON 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:
21229-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-2273
Provider Business Practice Location Address Fax Number:
301-631-1002
Provider Enumeration Date:
03/30/2009