Provider First Line Business Practice Location Address:
622 A NORTH EUTAW 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-225-3904
Provider Business Practice Location Address Fax Number:
410-500-4573
Provider Enumeration Date:
09/02/2018