Provider First Line Business Practice Location Address:
600 N WOLFE STREET
Provider Second Line Business Practice Location Address:
MEYER 279
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-7279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-5147
Provider Business Practice Location Address Fax Number:
410-502-4133
Provider Enumeration Date:
05/20/2007