Provider First Line Business Practice Location Address:
2600 LIBERTY HEIGHTS AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-7804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-4424
Provider Business Practice Location Address Fax Number:
410-383-7918
Provider Enumeration Date:
06/04/2006