Provider First Line Business Practice Location Address:
3701 EASTERN AVENUE
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:
410-327-7639
Provider Business Practice Location Address Fax Number:
410-342-8093
Provider Enumeration Date:
11/04/2005