Provider First Line Business Practice Location Address:
205 E PATAPSCO 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:
21225-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-355-4422
Provider Business Practice Location Address Fax Number:
410-355-0187
Provider Enumeration Date:
12/09/2006