Provider First Line Business Practice Location Address:
1003 E PATAPSCO 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:
21225-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-831-0191
Provider Business Practice Location Address Fax Number:
410-355-3971
Provider Enumeration Date:
01/16/2015