Provider First Line Business Practice Location Address:
3115 SMITH AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-4541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-4338
Provider Business Practice Location Address Fax Number:
410-526-5982
Provider Enumeration Date:
09/25/2006