Provider First Line Business Practice Location Address:
2145 WEST PATAPSCO AVENUE
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:
21230-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-644-6654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006