Provider First Line Business Practice Location Address:
208 E MELROSE 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:
21212-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-435-3755
Provider Business Practice Location Address Fax Number:
410-435-0547
Provider Enumeration Date:
12/29/2007