Provider First Line Business Practice Location Address:
2111 W PATAPSCO 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:
21230-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-644-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2015