Provider First Line Business Practice Location Address:
22 S GREENE STREET
Provider Second Line Business Practice Location Address:
3RD FLOOR ROOM N3E12
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:
410-328-8667
Provider Business Practice Location Address Fax Number:
410-821-4189
Provider Enumeration Date:
01/29/2007