Provider First Line Business Practice Location Address:
709 POPLAR GROVE ST
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:
21216-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-945-5555
Provider Business Practice Location Address Fax Number:
410-945-5590
Provider Enumeration Date:
01/13/2012