Provider First Line Business Practice Location Address:
630 W FAYETTE 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:
21201-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-2207
Provider Business Practice Location Address Fax Number:
410-328-9233
Provider Enumeration Date:
08/05/2006