Provider First Line Business Practice Location Address:
515 W 40TH 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:
21211-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-6064
Provider Business Practice Location Address Fax Number:
410-243-5514
Provider Enumeration Date:
06/19/2009