Provider First Line Business Practice Location Address:
4425 FITCH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-682-3000
Provider Business Practice Location Address Fax Number:
410-682-6890
Provider Enumeration Date:
05/30/2006