Provider First Line Business Practice Location Address:
19 WALKER AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-484-4840
Provider Business Practice Location Address Fax Number:
410-484-1084
Provider Enumeration Date:
11/08/2005