Provider First Line Business Practice Location Address:
821 N EUTAW ST
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-2250
Provider Business Practice Location Address Fax Number:
410-383-8378
Provider Enumeration Date:
11/04/2006