Provider First Line Business Practice Location Address:
5901 HOLABIRD AVE, SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-288-8947
Provider Business Practice Location Address Fax Number:
410-282-8454
Provider Enumeration Date:
09/23/2011