Provider First Line Business Practice Location Address:
5000 FRANKFORD 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:
21206-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-488-7042
Provider Business Practice Location Address Fax Number:
410-654-2781
Provider Enumeration Date:
09/05/2006