Provider First Line Business Practice Location Address:
1125 N PATTERSON PARK 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:
21213-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-563-3459
Provider Business Practice Location Address Fax Number:
410-276-0036
Provider Enumeration Date:
08/29/2012