Provider First Line Business Practice Location Address:
5 E HENRIETTA 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:
21230-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-659-0616
Provider Business Practice Location Address Fax Number:
410-539-1433
Provider Enumeration Date:
03/21/2006