Provider First Line Business Practice Location Address:
1042 PATAPSCO ST
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:
21230-4020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-305-9083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2006