Provider First Line Business Practice Location Address:
1546 EASTERN BLVD
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:
21221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-868-0244
Provider Business Practice Location Address Fax Number:
410-686-0370
Provider Enumeration Date:
01/03/2007