Provider First Line Business Practice Location Address:
2483 FREDERICK 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:
21223-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-233-8222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2014