Provider First Line Business Practice Location Address:
5418 PARK HEIGHTS 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:
21215-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-542-6900
Provider Business Practice Location Address Fax Number:
410-542-6707
Provider Enumeration Date:
09/19/2013