Provider First Line Business Practice Location Address:
2515 BOSTON ST
Provider Second Line Business Practice Location Address:
UNIT 602
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-675-7453
Provider Business Practice Location Address Fax Number:
410-558-1924
Provider Enumeration Date:
08/22/2007