Provider First Line Business Practice Location Address:
2245 EASTERN 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:
21231-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-675-6046
Provider Business Practice Location Address Fax Number:
410-563-1147
Provider Enumeration Date:
12/01/2010