Provider First Line Business Practice Location Address:
4713 LEEDS 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:
21227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-247-4741
Provider Business Practice Location Address Fax Number:
410-247-2346
Provider Enumeration Date:
02/15/2006