Provider First Line Business Practice Location Address:
801 W 36TH 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:
21211-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-1744
Provider Business Practice Location Address Fax Number:
410-366-1745
Provider Enumeration Date:
01/25/2007