Provider First Line Business Practice Location Address:
5443 PARK HEIGHTS 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:
21215-4615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-542-1600
Provider Business Practice Location Address Fax Number:
410-542-2938
Provider Enumeration Date:
11/17/2006