Provider First Line Business Practice Location Address:
835 LIGHT 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:
21230-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-727-3388
Provider Business Practice Location Address Fax Number:
410-727-1335
Provider Enumeration Date:
07/20/2006