Provider First Line Business Practice Location Address:
21 W 25TH 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:
21218-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-1717
Provider Business Practice Location Address Fax Number:
410-889-4167
Provider Enumeration Date:
12/23/2014