Provider First Line Business Practice Location Address:
301 SAINT PAUL PL
Provider Second Line Business Practice Location Address:
PHYS OFFICE BLDG., SUITE 701
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9423
Provider Business Practice Location Address Fax Number:
410-332-4533
Provider Enumeration Date:
06/02/2006