Provider First Line Business Practice Location Address:
1001 W SARATOGA 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:
21223-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-1290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2010