Provider First Line Business Practice Location Address:
5 SHIPPING PL
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:
21222-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-285-6380
Provider Business Practice Location Address Fax Number:
410-285-6382
Provider Enumeration Date:
01/23/2007