Provider First Line Business Practice Location Address:
98 N. BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 413, DEPT PM&R
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-4458
Provider Business Practice Location Address Fax Number:
301-502-3546
Provider Enumeration Date:
10/14/2008