Provider First Line Business Practice Location Address:
2209 SOUTH RD
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:
21209-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-542-9047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007