Provider First Line Business Practice Location Address:
2700 WASHINGTON 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:
21227-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-368-3984
Provider Business Practice Location Address Fax Number:
410-536-0636
Provider Enumeration Date:
01/29/2007