Provider First Line Business Practice Location Address:
401 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
WEINBERG 2268
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-3580
Provider Business Practice Location Address Fax Number:
410-614-1287
Provider Enumeration Date:
04/12/2011