Provider First Line Business Practice Location Address:
3901 CLARINTH RD
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:
21215-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-581-8801
Provider Business Practice Location Address Fax Number:
866-518-3010
Provider Enumeration Date:
04/21/2014