Provider First Line Business Practice Location Address:
5110 FREDERICK 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:
21229-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-4600
Provider Business Practice Location Address Fax Number:
443-640-4358
Provider Enumeration Date:
10/30/2015