Provider First Line Business Practice Location Address:
621 E PRATT ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-573-4502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2009