Provider First Line Business Practice Location Address:
6213 BURGESS 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:
21214-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-444-9481
Provider Business Practice Location Address Fax Number:
410-444-9482
Provider Enumeration Date:
07/06/2006