Provider First Line Business Practice Location Address:
210 W 28TH 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:
21211-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-779-7486
Provider Business Practice Location Address Fax Number:
866-379-4645
Provider Enumeration Date:
12/05/2016