Provider First Line Business Practice Location Address:
650 W. BALTIMORE ST.
Provider Second Line Business Practice Location Address:
5 SOUTH RM 5102
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:
410-706-7970
Provider Business Practice Location Address Fax Number:
410-706-3028
Provider Enumeration Date:
10/23/2006