Provider First Line Business Practice Location Address:
1340 EASTERN BLVD
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:
21221-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-780-7020
Provider Business Practice Location Address Fax Number:
410-780-3946
Provider Enumeration Date:
02/25/2007