Provider First Line Business Practice Location Address:
4714 EDMONDSON AVENUE
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:
21229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-566-4200
Provider Business Practice Location Address Fax Number:
410-566-1770
Provider Enumeration Date:
07/15/2006