Provider First Line Business Practice Location Address:
1190 W NORTHERN PKWY APT 105A
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:
21210-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-7899
Provider Business Practice Location Address Fax Number:
410-433-2288
Provider Enumeration Date:
02/13/2007