Provider First Line Business Practice Location Address:
650 W LOMBARD 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:
21201-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6335
Provider Business Practice Location Address Fax Number:
410-328-0987
Provider Enumeration Date:
06/14/2008