Provider First Line Business Practice Location Address:
3124 GREENMOUNT 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:
21218-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-5211
Provider Business Practice Location Address Fax Number:
410-366-0866
Provider Enumeration Date:
09/20/2007