Provider First Line Business Practice Location Address:
711 W 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-8525
Provider Business Practice Location Address Fax Number:
410-235-2006
Provider Enumeration Date:
01/15/2007