Provider First Line Business Practice Location Address:
730 N ASHBURTON 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:
21216-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-233-0684
Provider Business Practice Location Address Fax Number:
410-233-8540
Provider Enumeration Date:
10/02/2014