Provider First Line Business Practice Location Address:
1301 WOODBOURNE 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:
21239-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-433-1000
Provider Business Practice Location Address Fax Number:
410-435-2938
Provider Enumeration Date:
07/04/2006