Provider First Line Business Practice Location Address:
420 E. 25TH STREET
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:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-705-1331
Provider Business Practice Location Address Fax Number:
410-938-2237
Provider Enumeration Date:
05/29/2008