Provider First Line Business Practice Location Address:
5408 1/2 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:
21215-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-466-1800
Provider Business Practice Location Address Fax Number:
410-466-1811
Provider Enumeration Date:
08/09/2006