Provider First Line Business Practice Location Address:
3315 SPAULDING 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:
21215-5812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-763-6856
Provider Business Practice Location Address Fax Number:
484-822-4276
Provider Enumeration Date:
07/11/2009