Provider First Line Business Practice Location Address:
13 MARGARET 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:
21221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-391-6200
Provider Business Practice Location Address Fax Number:
410-391-6201
Provider Enumeration Date:
10/14/2006