Provider First Line Business Practice Location Address:
1490 W PATAPSCO 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:
21230-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-355-6900
Provider Business Practice Location Address Fax Number:
410-355-6910
Provider Enumeration Date:
09/24/2009