Provider First Line Business Practice Location Address:
640 BARTLETT AVENUE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-613-0506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006