Provider First Line Business Practice Location Address:
4209 NEWGATE AVE
Provider Second Line Business Practice Location Address:
CANTON PIER 11
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-6416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-631-7465
Provider Business Practice Location Address Fax Number:
410-631-7467
Provider Enumeration Date:
01/17/2008