Provider First Line Business Practice Location Address:
200 E NORTH AVE
Provider Second Line Business Practice Location Address:
THIRD PARTY BILLING, ROOM 201
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-8948
Provider Business Practice Location Address Fax Number:
410-545-6128
Provider Enumeration Date:
11/20/2006