Provider First Line Business Practice Location Address:
1216 E BALTIMORE ST
Provider Second Line Business Practice Location Address:
ATTN: COMMUNITY CARE CENTER
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-870-5483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2012