Provider First Line Business Practice Location Address:
938 W NORTH 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:
21217-3940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-669-8300
Provider Business Practice Location Address Fax Number:
410-669-0764
Provider Enumeration Date:
01/31/2011