Provider First Line Business Practice Location Address: 
1800 ORLEANS 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: 
21287-0010
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
410-683-8333
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/27/2015