Provider First Line Business Practice Location Address:
576 OLD TOWN MALL
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:
21202-4190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-276-3383
Provider Business Practice Location Address Fax Number:
410-276-3385
Provider Enumeration Date:
01/02/2008