Provider First Line Business Practice Location Address:
934 W NORTH 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:
21217-3940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-523-4700
Provider Business Practice Location Address Fax Number:
410-383-1401
Provider Enumeration Date:
03/20/2007