Provider First Line Business Practice Location Address:
5901 HOLABIRD AVE
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-288-6000
Provider Business Practice Location Address Fax Number:
410-633-5192
Provider Enumeration Date:
10/31/2016