Provider First Line Business Practice Location Address:
1023 N CALVERT 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:
21202-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-539-7737
Provider Business Practice Location Address Fax Number:
410-539-7739
Provider Enumeration Date:
03/20/2007