Provider First Line Business Practice Location Address:
200 EAST 33RD ST
Provider Second Line Business Practice Location Address:
SUITE 426
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-3381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-1133
Provider Business Practice Location Address Fax Number:
410-235-1267
Provider Enumeration Date:
12/13/2005