Provider First Line Business Practice Location Address:
4401 E FAIRMOUNT 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:
21224-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-534-5200
Provider Business Practice Location Address Fax Number:
410-534-5201
Provider Enumeration Date:
12/12/2007