Provider First Line Business Practice Location Address:
2800 MATHEWS ST
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:
21218-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-9200
Provider Business Practice Location Address Fax Number:
410-243-9290
Provider Enumeration Date:
09/15/2006