Provider First Line Business Practice Location Address:
2222 HARFORD RD
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:
21218-5538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-0054
Provider Business Practice Location Address Fax Number:
410-366-0068
Provider Enumeration Date:
04/29/2010