Provider First Line Business Practice Location Address:
4412-14 PARK HEIGHTS AVENUE
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:
21215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-466-4500
Provider Business Practice Location Address Fax Number:
410-367-2500
Provider Enumeration Date:
12/13/2011