Provider First Line Business Practice Location Address:
22 E 25TH 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:
21218-5142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-6280
Provider Business Practice Location Address Fax Number:
410-235-6281
Provider Enumeration Date:
12/04/2006