Provider First Line Business Practice Location Address:
200 FONT HILL AVE
Provider Second Line Business Practice Location Address:
HEALTH SUITE
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21223-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-0046
Provider Business Practice Location Address Fax Number:
410-545-6272
Provider Enumeration Date:
02/26/2006