Provider First Line Business Practice Location Address:
2507 PROCTOR LANE
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:
21234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-882-4100
Provider Business Practice Location Address Fax Number:
410-882-3479
Provider Enumeration Date:
04/26/2007