Provider First Line Business Practice Location Address:
900 W BALTIMORE 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:
21223-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-333-3265
Provider Business Practice Location Address Fax Number:
410-333-3063
Provider Enumeration Date:
02/16/2007