Provider First Line Business Practice Location Address:
22 SOUTH GREENE 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:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-5181
Provider Business Practice Location Address Fax Number:
410-706-5103
Provider Enumeration Date:
09/13/2006