Provider First Line Business Practice Location Address:
7161 HOLABIRD 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:
21222-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-285-6023
Provider Business Practice Location Address Fax Number:
410-282-8339
Provider Enumeration Date:
12/08/2007