Provider First Line Business Practice Location Address:
9919 PULASKI HWY
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:
21220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-780-4159
Provider Business Practice Location Address Fax Number:
410-780-5263
Provider Enumeration Date:
08/30/2006