Provider First Line Business Practice Location Address:
2435 W BELVEDERE AVE
Provider Second Line Business Practice Location Address:
SUITE 42
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-601-5523
Provider Business Practice Location Address Fax Number:
410-601-8946
Provider Enumeration Date:
12/15/2008