Provider First Line Business Practice Location Address:
416 E 30TH 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:
21218-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-889-0727
Provider Business Practice Location Address Fax Number:
410-889-0729
Provider Enumeration Date:
04/04/2007