Provider First Line Business Practice Location Address:
2400 KIRK 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:
21218-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-735-5397
Provider Business Practice Location Address Fax Number:
410-735-5393
Provider Enumeration Date:
05/14/2009