Provider First Line Business Practice Location Address:
2509 PENNSYLVANIA 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:
21217-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-225-2091
Provider Business Practice Location Address Fax Number:
410-669-8790
Provider Enumeration Date:
07/02/2012