Provider First Line Business Practice Location Address:
2305 ELSINORE 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:
21216-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-707-2396
Provider Business Practice Location Address Fax Number:
410-884-2897
Provider Enumeration Date:
04/16/2012