Provider First Line Business Practice Location Address:
2401 W BALTIMORE 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:
21223-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-945-7706
Provider Business Practice Location Address Fax Number:
410-233-9574
Provider Enumeration Date:
11/29/2005