Provider First Line Business Practice Location Address:
11 SLADE AVE.
Provider Second Line Business Practice Location Address:
#512
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-484-0000
Provider Business Practice Location Address Fax Number:
410-628-2818
Provider Enumeration Date:
12/29/2011