Provider First Line Business Practice Location Address:
4502 SCHENLEY 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:
21210-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-668-6942
Provider Business Practice Location Address Fax Number:
443-524-0850
Provider Enumeration Date:
05/10/2006