Provider First Line Business Practice Location Address:
1500 E MADISON 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:
21205-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-732-6721
Provider Business Practice Location Address Fax Number:
410-563-5051
Provider Enumeration Date:
12/15/2005