Provider First Line Business Practice Location Address:
4167 PATTERSON 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:
21215-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-764-2111
Provider Business Practice Location Address Fax Number:
410-764-9947
Provider Enumeration Date:
11/25/2005