Provider First Line Business Practice Location Address:
520 N FRANKLINTOWN 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:
21223-1052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-362-3838
Provider Business Practice Location Address Fax Number:
410-362-7118
Provider Enumeration Date:
05/20/2015