Provider First Line Business Practice Location Address:
3039 HAMILTON 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:
21214-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-319-9009
Provider Business Practice Location Address Fax Number:
410-319-9008
Provider Enumeration Date:
04/18/2007