Provider First Line Business Practice Location Address:
708 SPRINGFIELD 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:
21212-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-323-7917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2006