Provider First Line Business Practice Location Address:
3 S FREDERICK 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:
21202-4034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-327-6503
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2012