Provider First Line Business Practice Location Address:
701 W. PRATT ST
Provider Second Line Business Practice Location Address:
ROOM 569
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-2564
Provider Business Practice Location Address Fax Number:
410-328-0096
Provider Enumeration Date:
07/27/2007