Provider First Line Business Practice Location Address:
800 INGLESIDE 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:
21228-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-4661
Provider Business Practice Location Address Fax Number:
410-744-9423
Provider Enumeration Date:
03/02/2010