Provider First Line Business Practice Location Address:
4710 PENNINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21226-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-562-5248
Provider Business Practice Location Address Fax Number:
410-800-4781
Provider Enumeration Date:
02/22/2012