Provider First Line Business Practice Location Address:
911 N CAREY 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:
21217-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-523-5898
Provider Business Practice Location Address Fax Number:
410-523-5815
Provider Enumeration Date:
07/16/2008