Provider First Line Business Practice Location Address:
650 WEST BALTIMORE STREET
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:
21045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-7539
Provider Business Practice Location Address Fax Number:
410-706-0865
Provider Enumeration Date:
01/19/2012