Provider First Line Business Practice Location Address:
4701 MOUNT HOPE DR STE B
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:
21215-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-1060
Provider Business Practice Location Address Fax Number:
410-235-1309
Provider Enumeration Date:
09/02/2005