Provider First Line Business Practice Location Address:
810 LIGHT ST.
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-908-2099
Provider Business Practice Location Address Fax Number:
410-243-2507
Provider Enumeration Date:
04/19/2007