Provider First Line Business Practice Location Address:
3639 LIBERTY HEIGHTS 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:
21215-7139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-664-9200
Provider Business Practice Location Address Fax Number:
410-664-2560
Provider Enumeration Date:
05/12/2008