Provider First Line Business Practice Location Address:
703 S CLINTON 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:
21224-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-276-0176
Provider Business Practice Location Address Fax Number:
410-732-1890
Provider Enumeration Date:
03/15/2012