Provider First Line Business Practice Location Address:
19 W BARRE 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:
21201-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-480-4088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007