Provider First Line Business Practice Location Address:
2000 EDGEWOOD ST
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:
21216-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-291-2570
Provider Business Practice Location Address Fax Number:
410-233-5893
Provider Enumeration Date:
07/02/2015