Provider First Line Business Practice Location Address:
5441 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
SUITE# 16
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-941-2919
Provider Business Practice Location Address Fax Number:
410-630-5561
Provider Enumeration Date:
12/30/2013