Provider First Line Business Practice Location Address:
200 E PRATT 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:
21202-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-292-4800
Provider Business Practice Location Address Fax Number:
312-564-4059
Provider Enumeration Date:
10/24/2023